Modulation of hyperacusis and tinnitus loudness in tinnitus patients with and without hearing loss following 3 weeks of acoustic stimulation: A proof-of-concept study.

Tinnitus and hyperacusis are two debilitating conditions that are highly comorbid. It has been postulated that they may originate from similar pathophysiological mechanisms such as an increase in central gain. Interestingly, sound stimulation has been shown to reduce central gain and is currently used for the treatment of both conditions. This study investigates the effect of sound stimulation on both tinnitus and hyperacusis in the same patients. Two distinct series of tinnitus participants were tested: one with normal or near-normal hearing (n=16) and one with hearing loss (n=14). A broadband noise shaped to cover most of the tinnitus frequency spectrum was delivered through hearing aids using the noise generator feature (no amplification) and verified through real-ear measurements. Participants received sound stimulation for 3 weeks and were tested before (at baseline), then after 1 week and at the end of the 3 weeks of sound stimulation. There was also a 1-month follow-up after the end of the stimulation protocol. The measurements included self-reported measures of tinnitus and hyperacusis (VAS), validated questionnaires (THI, HQ) and psychoacoustic measurements (tinnitus battery and loudness functions). On both self-assessment (VAS of sound tolerance and tinnitus loudness) and psychoacoustic measures (loudness function and tinnitus loudness in dB), about 50% of tinnitus participants had a synchronous (either a decrease or an increase) modulation of hyperacusis and tinnitus loudness after 1 week and 3 weeks of acoustic stimulation and up to about 70% of participants at 1-M follow-up. The decrease of hyperacusis and tinnitus loudness was more prevalent in normal-hearing participants. There was a significant increase in tinnitus loudness during and following the stimulation in the group with hearing loss. Hyperacusis improvement as assessed by loudness function was significantly correlated with the intensity level of the acoustic stimulation (dB level of the noise produced by the noise generator) in tinnitus participants with normal/near-normal hearing thresholds. Our study partly supports the central gain hypothesis by showing synchronous modulation of hyperacusis and tinnitus loudness. It also shows beneficial effects of acoustic stimulation in some tinnitus individuals, in particular those with normal or near-normal hearing, while highlighting the importance of a careful fitting of sound generators to prevent increase. Since the amplification feature was not turned on in our study, future work should determine whether amplification alone, or in addition to acoustic stimulation (sound generators), would benefit to those with hearing loss.

Binaural Beats through the Auditory Pathway: From Brainstem to Connectivity Patterns.

Binaural beating is a perceptual auditory illusion occurring when presenting two neighboring frequencies to each ear separately. Several controversial claims have been attributed to binaural beats regarding their ability to entrain human brain activity and mood, in both the scientific literature and the marketing realm. Here, we sought to address those questions in a robust fashion using a single-blind, active-controlled protocol. To do so, we compared the effects of binaural beats with a control beat stimulation (monaural beats, known to entrain brain activity but not mood) across four distinct levels in the human auditory pathway: subcortical and cortical entrainment, scalp-level functional connectivity and self-reports. Both stimuli elicited standard subcortical responses at the pure tone frequencies of the stimulus [i.e., frequency following response (FFR)], and entrained the cortex at the beat frequency [i.e., auditory steady state response (ASSR)]. Furthermore, functional connectivity patterns were modulated differentially by both kinds of stimuli, with binaural beats being the only one eliciting cross-frequency activity. Despite this, we did not find any mood modulation related to our experimental manipulation. Our results provide evidence that binaural beats elicit cross frequency connectivity patterns, but weakly entrain the cortex when compared with monaural beat stimuli. Whether binaural beats have an impact on cognitive performance or other mood measurements remains to be seen and can be further investigated within the proposed methodological framework.

Middle Latency Responses to Optimized Chirps in Adult Cochlear Implant Users.

BACKGROUND: Cochlear implant (CI) outcomes can be assessed using objective measures that reflect the integrity of the auditory pathway. One such measure is the middle latency response (MLR), which can provide valuable information for clinicians. PURPOSE: Traditional stimuli for evoking MLRs, that is, clicks or tone bursts, do not stimulate all parts of the cochlea simultaneously, whereas chirp stimuli compensate for the cochlear neural delay and, therefore, produce more synchronous responses from the different neural elements of the cochlea. The purpose of the present study was to determine whether chirp stimuli can elicit reliable MLRs in CI users and whether those responses correlate with clinical outcomes and with deprivation-related factors. RESEARCH DESIGN: We presented 2,000 free-field optimized chirp stimuli to CI and control participants while their electroencephalography (EEG) was being recorded. STUDY SAMPLE: Twenty-four adult CI users and 24 matched normal-hearing (NH) individuals (age range from 18 to 63 years) participated in this study. DATA COLLECTIONS AND ANALYSIS: The EEG was recorded from 64 active electrodes placed on the scalp. EEG signals were processed using EEGLAB and ERPLAB toolboxes. We characterized the latencies and amplitudes of the different MLR components in both groups. RESULTS: Chirp stimuli reliably evoked qualitatively similar MLRs across all NH and CI participants with a couple of differences observed between the NH and CI group. Among the different MLR components, the Na latency was significantly shorter for the CI group. A significant amplitude difference was also found between groups for the Pa-Nb complex, with higher amplitudes observed in the NH group. Finally, there were no significant correlations between MLR latencies (or amplitudes) and clinical outcomes or deprivation-related measures. CONCLUSIONS: Free-field-presented optimized chirp stimuli were shown to evoke measurable and reliable MLRs in CI users. In this experiment, the MLR morphology in CI users was similar to those observed in NH participants. Even though we did not replicate here a significant relationship between MLR and speech perception measures, we were able to successfully collect acoustically evoked MLRs, which could constitute an important supplemental measure to the standard behavioral tests presently being used in postoperative clinical evaluation settings.

Exploring the Experience and Effects of Vocal Toning.

BACKGROUND: Toning is a form of vocalizing that utilizes the natural voice to express sounds ranging from cries, grunts, and groans to open vowel sounds and humming on the full exhalation of the breath. Music therapists are increasingly utilizing toning in their clinical practice for a variety of therapeutic aims. Yet the effects of toning are not widely understood, with limited research to date. OBJECTIVE: To gather and analyze descriptive data to better understand the experience and effects of self-administered toning. Primary aims were to: 1) understand participants' experiences with toning, and any effects resulting from their experiences; 2) measure participants' emotional response to toning and singing; and 3) examine similarities and differences across the two datasets. METHODS: Participants were 20 adults, ages 20-40 years, who were non-musicians. We conducted semi-structured interviews and used qualitative content analysis to identify major themes and subcategories related to participants' toning experiences. Participants also completed a 48-item questionnaire on music and emotions. Results from the interview and questionnaire data were then compared and contrasted. RESULTS: Results indicate that shifts in attention, awareness, and consciousness frequently occurred when individuals engaged in toning. "Meditative," "calm," and "relaxed" were the three most common descriptors of toning. In contrast, singing evoked stronger emotions and associations than toning, with the three most common descriptors including "nostalgia," "tenderness," and "joyful activation." Findings also suggest that the physical experience with vibrations and the sound of one's own voice may be attributes of toning that likely contribute to its success in inducing altered states of awareness, attention, and consciousness. CONCLUSIONS: This study significantly expands our understanding of the experience and effects of toning, and has direct implications for clinical practice, including the identification of effective strategies to successfully engage adults in toning.

Neural bases of rhythmic entrainment in humans: critical transformation between cortical and lower-level representations of auditory rhythm.

The spontaneous ability to entrain to meter periodicities is central to music perception and production across cultures. There is increasing evidence that this ability involves selective neural responses to meter-related frequencies. This phenomenon has been observed in the human auditory cortex, yet it could be the product of evolutionarily older lower-level properties of brainstem auditory neurons, as suggested by recent recordings from rodent midbrain. We addressed this question by taking advantage of a new method to simultaneously record human EEG activity originating from cortical and lower-level sources, in the form of slow (< 20 Hz) and fast (> 150 Hz) responses to auditory rhythms. Cortical responses showed increased amplitudes at meter-related frequencies compared to meter-unrelated frequencies, regardless of the prominence of the meter-related frequencies in the modulation spectrum of the rhythmic inputs. In contrast, frequency-following responses showed increased amplitudes at meter-related frequencies only in rhythms with prominent meter-related frequencies in the input but not for a more complex rhythm requiring more endogenous generation of the meter. This interaction with rhythm complexity suggests that the selective enhancement of meter-related frequencies does not fully rely on subcortical auditory properties, but is critically shaped at the cortical level, possibly through functional connections between the auditory cortex and other, movement-related, brain structures. This process of temporal selection would thus enable endogenous and motor entrainment to emerge with substantial flexibility and invariance with respect to the rhythmic input in humans in contrast with non-human animals.

Inhibition of Pain and Pain-Related Brain Activity by Heterotopic Noxious Counter-Stimulation and Selective Attention in Chronic Non-Specific Low Back Pain.

The aim of the present study was to assess inhibition of pain and somatosensory-evoked potentials (SEPs) by heterotopic noxious counter-stimulation (HNCS) and by selective attention in patients with chronic non-specific LBP. Seventeen patients and age/sex-matched controls were recruited (10 men, 7 women; mean age ±â€¯SD: 43.3 ±â€¯10.4 and 42.7 ±â€¯11.1, respectively). On average, patients with LBP reported pain duration of 7.6 ±â€¯6.5 years, light to moderate disability (19.3 ±â€¯5.7/100) and low clinical pain intensity (21.8 ±â€¯1.5/100), while pain catastrophizing, state and trait anxiety and depressive symptoms were not significantly different between groups (all p's >0.05). HNCS and selective attention had differential inhibitory effects on pain and SEP, but no difference was observed between groups. Across both groups, HNCS decreased pain (p = 0.06) as well as the N100 and the N150 components of SEP (p's <0.001), while selective attention only decreased pain (p < 0.01) and the N100 (p<0.001). In contrast, the P260 was decreased by HNCS only when attention was directed toward the HNCS stimulus (p<0.01). This indicates that patients with the characteristics described above do not show altered pain inhibitory mechanisms involved in HNCS and selective attention. Importantly, this experiment was carefully designed to control for non-specific effects associated with the repetition of the test stimulus and the effect of an innocuous counter-stimulation. It remains to be determined if these results hold for patients with severe LBP and psychological symptoms or whether symptom severity may be associated with pain inhibition deficits.

Neural Processing of Musical and Vocal Emotions Through Cochlear Implants Simulation.

Cochlear implants (CIs) partially restore the sense of hearing in the deaf. However, the ability to recognize emotions in speech and music is reduced due to the implant's electrical signal limitations and the patient's altered neural pathways. Electrophysiological correlations of these limitations are not yet well established. Here we aimed to characterize the effect of CIs on auditory emotion processing and, for the first time, directly compare vocal and musical emotion processing through a CI-simulator. We recorded 16 normal hearing participants' electroencephalographic activity while listening to vocal and musical emotional bursts in their original form and in a degraded (CI-simulated) condition. We found prolonged P50 latency and reduced N100-P200 complex amplitude in the CI-simulated condition. This points to a limitation in encoding sound signals processed through CI simulation. When comparing the processing of vocal and musical bursts, we found a delay in latency with the musical bursts compared to the vocal bursts in both conditions (original and CI-simulated). This suggests that despite the cochlear implants' limitations, the auditory cortex can distinguish between vocal and musical stimuli. In addition, it adds to the literature supporting the complexity of musical emotion. Replicating this study with actual CI users might lead to characterizing emotional processing in CI users and could ultimately help develop optimal rehabilitation programs or device processing strategies to improve CI users' quality of life.

Monkeys share the neurophysiological basis for encoding sound periodicities captured by the frequency-following response with humans.

The extraction and encoding of acoustical temporal regularities are fundamental for human cognitive auditory abilities such as speech or beat entrainment. Because the comparison of the neural sensitivity to temporal regularities between human and animals is fundamental to relate non-invasive measures of auditory processing to their neuronal basis, here we compared the neural representation of auditory periodicities between human and non-human primates by measuring scalp-recorded frequency-following response (FFR). We found that rhesus monkeys can resolve the spectrotemporal structure of periodic stimuli to a similar extent as humans by exhibiting a homologous FFR potential to the speech syllable /da/. The FFR in both species is robust and phase-locked to the fundamental frequency of the sound, reflecting an effective neural processing of the fast-periodic information of subsyllabic cues. Our results thus reveal a conserved neural ability to track acoustical regularities within the primate order. These findings open the possibility to study the neurophysiology of complex sound temporal processing in the macaque subcortical and cortical areas, as well as the associated experience-dependent plasticity across the auditory pathway in behaving monkeys.

Recording the human brainstem frequency-following-response in the free-field.

BACKGROUND: The human auditory brainstem frequency-following response (FFR) is an objective measure used to investigate the brainstem's encoding ability of sounds. Traditionally, FFRs are recorded under close-field conditions (earphones), but free-field stimulations (loudspeaker) have yet to be attempted, which would increase the applications of FFRs by making this technique accessible to those who cannot wear inserted transducers. Here we test the feasibility and reliability of measuring speech ABRs across free and close-field. NEW METHOD: The FFR was evoked by a 40-ms consonant-vowel (cv) /da/ syllable which was presented in the standard close-field conditions with insert earphones, and in a novel free-field condition via a loudspeaker. RESULTS: A well-defined FFR was observed for each stimulating method (free or close-field). We show that it is possible and reliable to elicit FFRs from a speaker and that these do not systematically differ from those elicited by conventional earphones. COMPARISON WITH EXISTING METHOD: Neural responses were subjected to a comparative within-subjects analysis, using standard measures found in the literature in order to quantify and compare the intrinsic (amplitude, noise, consistency), acoustic (latency, spectral amplitude) and reliability properties (intraclass correlation coefficients and Bland and Altman limits of agreement) of the neural signal. CONCLUSIONS: Reliable FFRs can be elicited using free-field presentation with comparable to acoustical, intrinsic and reliability properties as those elicited by standard close-field presentations.

Inhibitory effects of heterotopic noxious counter-stimulation on perception and brain activity related to Aß-fibre activation.

Heterotopic noxious counter-stimulation (HNCS) inhibits pain and pain processes through cerebral and cerebrospinal mechanisms. However, it is unclear whether HNCS inhibits non-nociceptive processes, which needs to be clarified for a better understanding of HNCS analgesia. The aim of this study was to examine the effects of HNCS on perception and scalp somatosensory evoked potentials (SEPs). Seventeen healthy volunteers participated in two counter-balanced sessions, including non-nociceptive (selective Aß-fibre activation) or nociceptive electrical stimulation, combined with HNCS. HNCS was produced by a 20-min cold pressor test (left hand) adjusted individually to produce moderate pain (mean ± SEM: 42.5 ± 5.3 on a 0-100 scale, where 0 is no pain and 100 the worst pain imaginable). Non-nociceptive electrical stimulation was adjusted individually at 80% of pain threshold and produced a tactile sensation in every subject. Nociceptive electrical stimulation was adjusted individually at 120% of RIII-reflex threshold and produced moderate pain (45.3 ± 4.5). Shock sensation was significantly decreased by HNCS compared with baseline for non-nociceptive (P < 0.001) and nociceptive (P < 0.001) stimulation. SEP peak-to-peak amplitude at Cz was significantly decreased by HNCS for non-nociceptive (P < 0.01) and nociceptive (P < 0.05) stimulation. These results indicate that perception and brain activity related to Aß-fibre activation are inhibited by HNCS. The mechanisms of this effect remain to be investigated to clarify whether it involves inhibition of spinal wide-dynamic-range neurons by diffuse noxious inhibitory controls, supraspinal processes or both.

Individual Differences in the Frequency-Following Response: Relation to Pitch Perception.

The scalp-recorded frequency-following response (FFR) is a measure of the auditory nervous system's representation of periodic sound, and may serve as a marker of training-related enhancements, behavioural deficits, and clinical conditions. However, FFRs of healthy normal subjects show considerable variability that remains unexplained. We investigated whether the FFR representation of the frequency content of a complex tone is related to the perception of the pitch of the fundamental frequency. The strength of the fundamental frequency in the FFR of 39 people with normal hearing was assessed when they listened to complex tones that either included or lacked energy at the fundamental frequency. We found that the strength of the fundamental representation of the missing fundamental tone complex correlated significantly with people's general tendency to perceive the pitch of the tone as either matching the frequency of the spectral components that were present, or that of the missing fundamental. Although at a group level the fundamental representation in the FFR did not appear to be affected by the presence or absence of energy at the same frequency in the stimulus, the two conditions were statistically distinguishable for some subjects individually, indicating that the neural representation is not linearly dependent on the stimulus content. In a second experiment using a within-subjects paradigm, we showed that subjects can learn to reversibly select between either fundamental or spectral perception, and that this is accompanied both by changes to the fundamental representation in the FFR and to cortical-based gamma activity. These results suggest that both fundamental and spectral representations coexist, and are available for later auditory processing stages, the requirements of which may also influence their relative strength and thus modulate FFR variability. The data also highlight voluntary mode perception as a new paradigm with which to study top-down vs bottom-up mechanisms that support the emerging view of the FFR as the outcome of integrated processing in the entire auditory system.

Impairments in musical abilities reflected in the auditory brainstem: evidence from congenital amusia.

Congenital amusia is a neurogenetic condition, characterized by a deficit in music perception and production, not explained by hearing loss, brain damage or lack of exposure to music. Despite inferior musical performance, amusics exhibit normal auditory cortical responses, with abnormal neural correlates suggested to lie beyond auditory cortices. Here we show, using auditory brainstem responses to complex sounds in humans, that fine-grained automatic processing of sounds is impoverished in amusia. Compared with matched non-musician controls, spectral amplitude was decreased in amusics for higher harmonic components of the auditory brainstem response. We also found a delayed response to the early transient aspects of the auditory stimulus in amusics. Neural measures of spectral amplitude and response timing correlated with participants' behavioral assessments of music processing. We demonstrate, for the first time, that amusia affects how complex acoustic signals are processed in the auditory brainstem. This neural signature of amusia mirrors what is observed in musicians, such that the aspects of the auditory brainstem responses that are enhanced in musicians are degraded in amusics. By showing that gradients of music abilities are reflected in the auditory brainstem, our findings have implications not only for current models of amusia but also for auditory functioning in general.

Pain modulation induced by respiration: phase and frequency effects.

The voluntary control of respiration is used as a common means to regulate pain and emotions and is fundamental to various relaxation and meditation techniques. The aim of the present study was to examine how breathing frequency and phase affect pain perception, spinal nociceptive activity (RIII-reflex) and brain activity (scalp somatosensory-evoked potentials - SEP's). In 20 healthy volunteers, painful electric shocks individually adjusted to 120% of the RIII-reflex threshold were delivered to the sural nerve near the end of inspiration or expiration phases, during three cued-breathing conditions: (1) slow breathing (0.1 Hz) with slow (4s) inspiration (0.1Hz-SlowIns), (2) slow breathing (0.1 Hz) with fast (2s) inspiration (0.1 Hz-FastIns), and (3) normal breathing (0.2 Hz) with fast (2s) inspiration (0.2 Hz). Pain ratings were not affected by breathing patterns (p=0.3), but were significantly lower during inspiration compared with expiration (p=0.02). This phase effect was also observed on the N100 component of SEP's, but only in the 0.1-Hz-FastIns condition (p=0.03). In contrast, RIII-reflex amplitude was greater during inspiration compared with expiration (p=0.02). It was also decreased in the 0.1-Hz-SlowIns compared with the 0.2-Hz condition (p=0.01). Slow breathing also increased the amplitude of respiratory sinus arrhythmia (RSA), although these changes were not significantly associated with changes in pain responses. In conclusion, this study shows that pain and pain-related brain activity may be reduced during inspiration but these changes are dissociated from spinal nociceptive transmission. The small amplitude of these effects suggests that factors other than respiration contribute to the analgesic effects of relaxation and meditation techniques.