[Related noise exposure and auditory consequence during transcranial magnetic stimulation: new insights and review of the literature]. / Exposition sonore et répercussions auditives au cours de la stimulation magnétique transcrânienne répétitive: données récentes et revue de la littérature.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neurostimulation tool with increasing therapeutic applications in neurology, psychiatry and in the treatment of chronic tinnitus, and with a growing interest in cognitive neuroscience. One of its side effects is the loud click sound generated simultaneously to the magnetic pulse, which depends both on the equipment and rTMS intensity. This impulse sound could transiently modify peripheral hearing mechanisms, and hence hearing thresholds, both in patients and in rTMS practitioners. Furthermore, if no precautions are taken, especially in subjects with several risks factors for hearing loss, it is possible that the repetition of exposure could lead to more definitive changes in hearing thresholds. These issues are often neglected, although they could have specific relevance in rTMS treatment for tinnitus or in auditory cognitive neuroscience. This review specifically deals with noise exposure during rTMS and its potential consequences on the auditory system. It provides several practical solutions to help minimize exposure.

Effects of hearing aid fitting on the perceptual characteristics of tinnitus.

Restoration of auditory input through the use of hearing aids has been proposed as a potentially important means of altering tinnitus among those tinnitus sufferers who experience significant sensorineural hearing loss. In animal models of neural plasticity induced by noise trauma, high-frequency stimulation in deafferented regions of the auditory spectrum has been shown to modulate cortical reorganization after hearing loss, a result which suggests that the neural basis of tinnitus is subject to interference by acoustic stimulation. This study drew on deafferentation models to investigate the effect of hearing aids on the psychoacoustic properties of the tinnitus sensation, using both conventional amplification and high-bandwidth amplification regimes. The tinnitus percept was affected only weakly in the conventional amplification group, and was not at all affected in the high-bandwidth group. The changes observed under conventional, low-to-medium frequency amplification may indicate that the perceptual characteristics of tinnitus depend on the pattern of sensory inputs - notably a contrast in activity between adjacent central auditory regions of more and less afferent activity - while the absence of modifications in the high-bandwidth amplification group suggests limit on the tractability of the tinnitus percept. This limit to the malleability of the tinnitus percept may arise from either the extent of hearing deficits or the duration and robustness of the neuroplastic changes that originally give rise to tinnitus.

The temporal relationship between speech auditory brainstem responses and the acoustic pattern of the phoneme /ba/ in normal-hearing adults.

OBJECTIVE: To investigate the temporal relationship between speech auditory brainstem responses and acoustic pattern of the phoneme /ba/. METHODS: Speech elicited auditory brainstem responses (Speech ABR) to /ba/ were recorded in 23 normal-hearing subjects. Effect of stimulus intensity was assessed on Speech ABR components latencies in 11 subjects. The effect of different transducers on electromagnetic leakage was also measured. RESULTS: Speech ABR showed a reproducible onset response (OR) 6ms after stimulus onset. The frequency following response (FFR) waveform mimicked the 500Hz low pass filtered temporal waveform of phoneme /ba/ with a latency shift of 14.6ms. In addition, the OR and FFR latencies decreased with increasing stimulus intensity, with a greater rate for FFR (-1.4ms/10dB) than for OR (-0.6ms/10dB). CONCLUSIONS: A close relationship was found between the pattern of the acoustic stimulus and the FFR temporal structure. Furthermore, differences in latency behaviour suggest different generation mechanisms for FFR and OR. SIGNIFICANCE: The results provided further insight into the temporal encoding of basic speech stimulus at the brainstem level in humans.

Effect of stimulus frequency and stimulation site on the N1m response of the human auditory cortex.

The aim of the present study was to investigate the functional organization of the auditory cortex for pure tones of 1, 2, 4, 6, 8 and 12 kHz. Ten subjects were tested with a whole-head magnetometer (151 channels). The location, latency and amplitude of the generators of the N1m (the main component of the response, peaking approximately at 100 ms) were explored simultaneously in the right and left hemispheres under monaural stimulation. Our results revealed that tonotopy is a rather complex functional organization of the auditory cortex. From 1 to 12 kHz, tonotopic maps were found for contralateral as well as for ipsilateral stimulation: N1m generators were found to be tonotopically organized mainly in an anterior-posterior direction in both hemispheres, whatever the stimulated ear, but also in an inferior-superior direction in the right hemisphere. Furthermore, latencies were longer in the left than in the right hemisphere. Two different representations of spectral distribution were found in the right auditory cortex: one for ipsilateral and one for contralateral stimulation.

Assessment of medial olivocochlear system function in pre-term and full-term newborns using a rapid test of transient otoacoustic emissions.

This study was conducted to investigate maturation of the medial olivocochlear efferent system (MOCS) in pre- and full-term neonates using Quickscreen (Otodynamics Ltd) and to confirm previous findings on transient otoacoustic emission (TEOAE) suppression in neonates. MOCS maturation was investigated in 46 neonates born at the Chaim Sheba Medical Center, Tel Hashomer, Israel, using Quickscreen. All neonates were normal with no family history of general or auditory disease and no risk factors for hearing impairment. MOCS function appears gradually in human pre-term neonates and is considered to reach maturity shortly after term birth. The clinical value of MOCS testing in specific populations of newborns at risk for hearing and/or brainstem function can be legitimately raised as activation of the MOCS clearly alters cochlear output. The present results can be interpreted to support the testing of infants at risk of developing abnormal MOCS function using a commercially available rapid TEOAE measurement system.

Medial olivocochlear bundle activation and perceived auditory intensity in humans.

In order to test the hypothesis of a role of cochlear efferent activity in intensity perception in humans, loudness functions, loudness integration, and loudness summation were measured in the absence and in the presence of contralateral noise in normal-hearing subjects. Additionally, relationships with the effect of the noise on evoked otoacoustic emissions (EOAEs) were tested, and comparisons with vestibular neurotomy patients were performed. Overall, the results failed to demonstrate significant effects of contralateral noise stimulation on loudness functions and loudness integration. Furthermore, no significant differences were found in vestibular neurotomy patients. A significant effect of contralateral noise on loudness summation was noted, but was not related to the effect on otoacoustic emissions. The present results fail to support the notion that efferent influences onto the cochlear compression have a significant perceptual effect.

Influence of focused auditory attention on cochlear activity in humans.

The mammalian auditory system contains descending pathways that originate in the cortex and relay at various intermediate levels before reaching the peripheral sensory organ of Corti. The last link in this chain consists of the olivocochlear bundle. The activity of this bundle can be measured through otoacoustic emissions, which are acoustic signatures of the cochlear biomechanical activity. In the present study, it was hypothesized that frequency-specific activation of the olivocochlear bundle in the contralateral ear would show up as frequency-specific variations in otoacoustic emission amplitude in the ipsilateral ear. Two groups of young adult subjects participated in this experiment. Evoked otoacoustic emissions were recorded in the ipsilateral ear at two test frequencies (1 and 2 kHz). Subjects had to detect probe tones at a given frequency in background noise in the contralateral ear. Larger efferent activation was measured at test frequencies on which attention is focused. This result provides evidence for an influence of attention on the auditory periphery via descending projections.

Differential recruitment of the speech processing system in healthy subjects and rehabilitated cochlear implant patients.

Differences in cerebral activation between control subjects and post-lingually deaf rehabilitated cochlear implant patients were identified with PET under various speech conditions of different linguistic complexity. Despite almost similar performance in patients and controls, different brain activation patterns were elicited. In patients, an attentional network including prefrontal and parietal modality-aspecific attentional regions and subcortical auditory regions was over-activated irrespective of the nature of the speech stimuli and during expectancy of speech stimuli. A left temporoparietal semantic region was responsive to meaningless stimuli (vowels). In response to meaningful stimuli (words, sentences, story), left middle and inferior temporal semantic regions and posterior superior temporal phonological regions were under-activated in patients, whereas anterior superior temporal phonological regions were over-activated. These differences in the recruitment of the speech comprehension system reflect the alternative neural strategies that permit speech comprehension after cochlear implantation.

Activation of medial olivocochlear efferent system in humans: influence of stimulus bandwidth.

The activity of the medial olivocochlear bundle (MOCB) can be studied in humans through variations in the level of evoked otoacoustic emissions (EOAEs) elicited by contralateral acoustic stimuli (CAS). The present study sought to investigate how the activity of the MOC system at a given frequency, as measured through the contralateral suppression of tone-pip EOAEs, depends on the bandwidth of the contralateral stimulus. EOAEs were recorded in 155 normal-hearing subjects, successively with and without contralateral stimuli whose bandwidth, center frequency and level were systematically varied. We showed a clear dependence of contralateral EOAE suppression on bandwidth demonstrating increased suppression with increased bandwidth over about two octaves around the center frequency of the noise. This effect was obtained irrespective of whether contralateral noise energy was kept constant independently of bandwidth or not, which indicates a role of bandwidth per se in contralateral EOAE suppression. Results are interpreted in terms of a simple model of MOCB activation mechanisms including peripheral bandpass filtering, within-channel compression and across-channel spatial summation by the afferent paths. Complementary experiments suggested a greater effectiveness of increases in bandwidth on the upper than on the lower side and of frequency components akin to or remote from the test frequency than of intermediate bands. Finally, these results were complemented by detailed spectrum analyses of the EOAE level variations induced by the different noises, which revealed that whilst noise components close to or remote from the center frequency generally attenuated EOAE level, intermediate components could in some cases lead to a relative increase in EOAE level. These results can further be explained by assuming different positive and negative weights on the inputs to the spatial summation process depending on their position relative to the center frequency.

Sinusoidal amplitude modulation alters contralateral noise suppression of evoked otoacoustic emissions in humans.

It is well established that low-level broad band noise can elicit an amplitude decrease in evoked otoacoustic emissions recorded in the opposite ear. However, the influence of the temporal characteristics of the contralateral stimulus on this effect remains largely unknown. In the present study, otoacoustic emissions evoked by 60 dB SPL clicks were recorded in 19 normal-hearing subjects using the Otodynamics IL088, successively in absence and presence of a contralateral noise that was either steady or modulated sinusoidally in amplitude at different depths (from 25% to 100% in 25 point steps) and rates (from 50 Hz to 800 Hz in half-octave steps). The energy was kept constant whatever the modulation depth. The results showed that the evoked otoacoustic-emission attenuation effect induced by contralateral stimulation varied depending on the modulation depth and frequency of the contralateral amplitude-modulated noise. The largest suppression effect was observed at the 100 Hz modulation frequency and the 100% modulation depth. The 50 Hz modulation resulted in less suppression than with unmodulated noise. An interpretation of these results in terms of the influence of temporal amplitude fluctuations falling within a certain range on medial olivocochlear bundle activity is discussed.

Stronger bilateral efferent influences on cochlear biomechanical activity in musicians than in non-musicians.

The auditory sensory end organ is under the control of the central nervous system via efferent projections. Contralateral suppression of otoacoustic emissions (acoustic signatures of the cochlear biomechanical activity) provides a non-invasive approach to assess olivocochlear efferent activity in humans. Using this approach, the present study compared professional musicians with musically-inexperienced subjects. The results revealed stronger bilateral cochlear suppression, suggesting larger efferent influences in both ears, in musicians. Furthermore, in indicating no difference in left/right asymmetry of efferent-mediated suppression between the two groups, the present findings suggest that the observed differences in olivocochlear activity reflect bilaterally-enhanced activity of the cortical auditory structures in musicians rather than differences in cerebral hemispheric asymmetry between the two groups.

Peripheral auditory lateralization assessment using TEOAEs.

Previous studies indicate a left-right asymmetry in the function of peripheral auditory system. Contralateral acoustic suppression of TEOAEs (transient evoked otoacoustic emissions) enables assessment of medial olivocochlear efferent system functioning, and has demonstrated that this system is more effective in the right than in the left ear. Moreover, TEOAE amplitudes are lower in the left than in the right ear. The aim of the present experiment was to verify firstly the absence of a relationship between medial efferent system asymmetry and TEOAE amplitude asymmetry, and secondly to study TEOAE input/output function slopes. There was no link between the asymmetries in TEOAE amplitude and in the medial efferent system functioning. Further, as previously shown, the medial olivocochlear system increased the TEOAE input/output function slopes. These TEOAE input/output function slopes seem to be consistent factors in peripheral asymmetry since the slope is lower in the right than in the left ear. Moreover, the lower the TEOAE amplitudes, the greater the TEOAE slopes. The slope asymmetry of the two ears could correspond to earlier saturation or a lower augmentation ability of the TEOAE response in the right ear, where the TEOAE amplitude is higher. This asymmetry in growth slopes reinforces the notion of peripheral auditory lateralization.

Contralateral frequency-modulated tones suppress transient-evoked otoacoustic emissions in humans.

In order to test the sensitivity of the human medial olivocochlear bundle (MOCB) to stimulus frequency fluctuations, changes in transient-evoked otoacoustic emission (TEOAE) amplitude induced by frequency modulated (FM) tones were measured in 18 normal-hearing subjects. The results revealed that TEOAE amplitude was reduced by contralateral FM tones at 40 dB above pure-tone threshold, with significant influences of both modulation rate (MR) and modulation depth (MD). This finding is discussed in the light of other recent results indicating amplitude fluctuation and frequency bandwidth effects in MOCB activation in humans.

Medial olivocochlear system stabilizes active cochlear micromechanical properties in humans.

To investigate the involvement of the medial olivocochlear system (MOCS) in outer hair cell (OHC) motility stabilization, evoked otoacoustic emissions (EOAEs) were recorded in 20 normal-hearing subjects and in eight vestibular-neurotomized subjects, successively in the presence and absence of low-intensity contralateral acoustic stimulation. Intrasubject EOAE amplitude variability was assessed as the standard deviation computed over several successive recordings. In normal-hearing subjects, a significantly lower EOAE amplitude variability with contralateral acoustic stimulation (CAS) was observed in subjects in whom the CAS induced the greatest EOAE amplitude reduction. This result could not be attributed to the EOAE amplitude reduction itself, since variability was otherwise found to increase when EOAE amplitude decreased. Moreover, statistically significant correlations between EOAE amplitude attenuation and EOAE amplitude variability under CAS were observed. In the eight subjects operated for vestibular neurotomy, no such effect was found. Being sectioned in vestibular-neurotomized subjects, the MOCS can no longer exert its effects. These results strongly support the notion that MOCS activity, as induced by CAS, elicits a reduction in EOAE amplitude variability in normal-hearing subjects. This finding and some of its possible implications for understanding the role of the MOCS in hearing in humans are discussed.

Suppression of otoacoustic emission is unchanged after several minutes of contralateral acoustic stimulation.

The influence of variable durations of contralateral acoustic stimulation on the suppression of click-evoked otoacoustic emissions was investigated in order to determine whether olivocochlear efferent fibers are equally effective whatever the acoustical stimulation duration or if they show fatigue. The suppression effect was measured for contralateral stimulus durations ranging from 10 to 180 s prior to the onset of otoacoustic emission recording, and continuing throughout the recording time (60 s). No significant stimulus duration effect was found.

Medial olivocochlear efferent system in humans studied with amplitude-modulated tones.

Evoked otoacoustic emissions (EOAEs) are assumed to be generated by outer hair cells (OHCs). It is now generally accepted that EOAEs represent a means of functional exploration of the active micromechanical properties of OHCs. Efferent fibers of the medial olivocochlear system (MOCS) are connected along the sides and the bases of OHCs. Some studies have shown that a suppression effect on EOAE amplitude is induced by the MOCS neurons during contralateral stimulation, presumably by modification of OHC motility. The contralateral acoustic stimuli used in experiments on the EOAE suppression effect have consisted mainly of sounds without a slow temporal fluctuation in their envelopes (broad-band noise, narrow-band noise, pure tones, or clicks). To elucidate further the parameters of MOCS activation, in the present study we looked at the contralateral suppression effect of amplitude-modulated (AM) tones. The results showed that EOAE amplitude was reduced with AM tones compared with no contralateral acoustic stimulation. The suppression effect mainly depended on three parameters. 1) Contralateral stimulation intensity: EOAE suppression occurred only with intensities > or = 40 dB SL. 2) The greater the modulation depth, the greater the suppression effect: statistical analysis showed a significant effect for 75 and 100% modulation depth. 3) The 100- and 140-Hz modulation frequencies gave the greatest suppression effect for 100 and 75% modulation depths. The suppression effect was frequency specific. The greatest decreases were observed when the carrier frequency of the contralateral AM tone was close to the frequency of the EOAE under study, i.e., 1 and 2 kHz. Acoustic cross talk and middle ear effects, which cannot be completely excluded, are discussed. However, the demonstrated frequency specificity of the EOAE suppression effect, together with observed presence of contralateral EOAE suppression in patients without stapedial reflex and the very weak intensities used (i.e., below acoustic reflex threshold), suggested that it was unlikely that the observed effects were due merely to middle ear reflexes. Our results confirm further the contralateral suppression effect on human cochlea mechanisms and show that the suppression effect can be influenced by amplitude modulations of the suppressor, characteristic of sounds in the environment.

Difference in cochlear efferent activity between musicians and non-musicians.

The present study aimed to confirm and extend the finding, suggested by the results of a previous study, of different auditory neural efferent functioning in musicians compared with non-musicians. The activity of the medial olivocochlear bundle (MOCB), an auditory efferent subsystem, was measured through the contralaterally induced attenuation of the amplitude of evoked otoacoustic emissions (EOAEs) in two groups, one of musicians and one of non-musicians, paired for age and sex. The results indicated a statistically significant difference between the two groups, with the musicians showing greater amplitude reduction upon contralateral noise stimulation than non-musicians (U-test, U = 204, p < 0.025, n = 32). These results indicate greater MOCB activity in musicians than in non-musicians. The possible origins and implications of this finding are discussed.

Influence of contralateral noise on distortion product latency in humans: is the medial olivocochlear efferent system involved?

To test the hypothesis of temporal modifications of cochlear responses when medial efferents are activated, otoacoustic emission latencies were estimated in 16 normal human subjects, in the presence and absence of a contralateral broadband noise, using measurements of the phase of the 2f1-f2 distortion product (group latency method). Significant decrease in the latency of lower frequency (0.8-2.7 kHz) emissions was found in the presence of increasing levels of contralateral sound, and this effect disappeared when the primary-tone levels increased to 60 dB SPL. To ensure that effects were not attributable to mechanisms involving middle ear structures, susceptible to activation by contralateral sound, latency measures were performed in seven subjects whose efferents were severed during a vestibular neurotomy and in two subjects with paralyzed stapedial muscle. Results in patients were compared to those obtained in three surgical control patients with intact efferent bundle, and in eight other normal subjects. All the subject groups exhibited a decrease in latency under contralateral sound except the patients with the severed efferent system who showed increased latencies.

Effect of contralateral acoustic stimulation on the growth of click-evoked otoacoustic emissions in humans.

Input-output (I/O) functions of click-evoked otoacoustic emissions (CEOAEs) were obtained over a 12 dB range for 64 normally hearing adult listeners with and without contralateral broadband noise (BBN). Contralateral acoustic stimulation (CAS) is a convenient way of suppressing responses to ipsilateral stimuli, probably acting via the medial olivocochlear system (MOCS). The present study shows that this contralateral sound suppression of CEOAEs is largest at low stimulus levels. In fact, the curves obtained under CAS approach the curves obtained without CAS as stimulus level rises. I/O slope analysis for the whole study population (n = 64) showed a slight but significant rise in slope with BBN, which may be interpreted as I/O function decompression. A loss of contralateral suppression effect at high ipsilateral stimulus levels was found in both very low and very high amplitude CEOAE subjects, despite the fact that I/O slopes differed between these two groups, whereas rise in slope under contralateral stimulation failed to be found for these same 2 groups of 16 subjects each. These findings clearly indicate that the MOCS is mostly functional at low sound levels, and suggest that the study of CEOAE I/O slope alteration under CAS may help specify one form of MOCS action on cochlear functioning.

Involvement of the olivocochlear bundle in the detection of tones in noise.

To investigate the involvement of auditory efferents in hearing-in-noise in humans, olivocochlear bundle (OCB) functioning and detection-in-noise abilities were compared in 30 subjects. OCB function was assessed in terms of contralateral attenuation of evoked otoacoustic emissions (EOAE): i.e., the reduction in EOAE amplitude elicited by a 30-dB SL contralateral broadband noise. Correspondingly, the detection thresholds for 1- and 2-kHz tone pips embedded in 50-dB SPL broadband noise were measured in the same ear as the EOAEs, successively in the presence and in the absence of a 30-dB SL broadband noise in the opposite ear. The shifts in detection threshold induced by the contralateral stimulation could thus be compared to those in EOAEs. The results indicated significant statistical correlations between the contralateral attenuation of EOAEs and (1) the detection threshold of the 2-kHz signal and (2) the contralaterally induced shift in the 1- and 2-kHz thresholds. Furthermore, the correlation between contralaterally induced reduction of EOAE amplitude and contralaterally induced threshold shift was observed only in the group of subjects who had first performed the detection task in the presence of contralateral stimulation. These results, which suggest that OCB is involved in detection of tones in noise in humans, are discussed in relation to previous physiological and behavioral studies of OCB function.