Inaccurate cortical tracking of speech in adults with impaired speech perception in noise.

Impaired speech perception in noise despite normal peripheral auditory function is a common problem in young adults. Despite a growing body of research, the pathophysiology of this impairment remains unknown. This magnetoencephalography study characterizes the cortical tracking of speech in a multi-talker background in a group of highly selected adult subjects with impaired speech perception in noise without peripheral auditory dysfunction. Magnetoencephalographic signals were recorded from 13 subjects with impaired speech perception in noise (six females, mean age: 30 years) and matched healthy subjects while they were listening to 5 different recordings of stories merged with a multi-talker background at different signal to noise ratios (No Noise, +10, +5, 0 and -5 dB). The cortical tracking of speech was quantified with coherence between magnetoencephalographic signals and the temporal envelope of (i) the global auditory scene (i.e. the attended speech stream and the multi-talker background noise), (ii) the attended speech stream only and (iii) the multi-talker background noise. Functional connectivity was then estimated between brain areas showing altered cortical tracking of speech in noise in subjects with impaired speech perception in noise and the rest of the brain. All participants demonstrated a selective cortical representation of the attended speech stream in noisy conditions, but subjects with impaired speech perception in noise displayed reduced cortical tracking of speech at the syllable rate (i.e. 4-8 Hz) in all noisy conditions. Increased functional connectivity was observed in subjects with impaired speech perception in noise in Noiseless and speech in noise conditions between supratemporal auditory cortices and left-dominant brain areas involved in semantic and attention processes. The difficulty to understand speech in a multi-talker background in subjects with impaired speech perception in noise appears to be related to an inaccurate auditory cortex tracking of speech at the syllable rate. The increased functional connectivity between supratemporal auditory cortices and language/attention-related neocortical areas probably aims at supporting speech perception and subsequent recognition in adverse auditory scenes. Overall, this study argues for a central origin of impaired speech perception in noise in the absence of any peripheral auditory dysfunction.

Tracking the Effects of Top-Down Attention on Word Discrimination Using Frequency-tagged Neuromagnetic Responses.

Discrimination of words from nonspeech sounds is essential in communication. Still, how selective attention can influence this early step of speech processing remains elusive. To answer that question, brain activity was recorded with magnetoencephalography in 12 healthy adults while they listened to two sequences of auditory stimuli presented at 2.17 Hz, consisting of successions of one randomized word (tagging frequency = 0.54 Hz) and three acoustically matched nonverbal stimuli. Participants were instructed to focus their attention on the occurrence of a predefined word in the verbal attention condition and on a nonverbal stimulus in the nonverbal attention condition. Steady-state neuromagnetic responses were identified with spectral analysis at sensor and source levels. Significant sensor responses peaked at 0.54 and 2.17 Hz in both conditions. Sources at 0.54 Hz were reconstructed in supratemporal auditory cortex, left superior temporal gyrus (STG), left middle temporal gyrus, and left inferior frontal gyrus. Sources at 2.17 Hz were reconstructed in supratemporal auditory cortex and STG. Crucially, source strength in the left STG at 0.54 Hz was significantly higher in verbal attention than in nonverbal attention condition. This study demonstrates speech-sensitive responses at primary auditory and speech-related neocortical areas. Critically, it highlights that, during word discrimination, top-down attention modulates activity within the left STG. This area therefore appears to play a crucial role in selective verbal attentional processes for this early step of speech processing.

Cortical Tracking of Speech-in-Noise Develops from Childhood to Adulthood.

In multitalker backgrounds, the auditory cortex of adult humans tracks the attended speech stream rather than the global auditory scene. Still, it is unknown whether such preferential tracking also occurs in children whose speech-in-noise (SiN) abilities are typically lower compared with adults. We used magnetoencephalography (MEG) to investigate the frequency-specific cortical tracking of different elements of a cocktail party auditory scene in 20 children (age range, 6-9 years; 8 females) and 20 adults (age range, 21-40 years; 10 females). During MEG recordings, subjects attended to four different 5 min stories, mixed with different levels of multitalker background at four signal-to-noise ratios (SNRs; noiseless, +5, 0, and -5 dB). Coherence analysis quantified the coupling between the time courses of the MEG activity and attended speech stream, multitalker background, or global auditory scene, respectively. In adults, statistically significant coherence was observed between MEG signals originating from the auditory system and the attended stream at <1, 1-4, and 4-8 Hz in all SNR conditions. Children displayed similar coupling at <1 and 1-4 Hz, but increasing noise impaired the coupling more strongly than in adults. Also, children displayed drastically lower coherence at 4-8 Hz in all SNR conditions. These results suggest that children's difficulties to understand speech in noisy conditions are related to an immature selective cortical tracking of the attended speech streams. Our results also provide unprecedented evidence for an acquired cortical tracking of speech at syllable rate and argue for a progressive development of SiN abilities in humans.SIGNIFICANCE STATEMENT Behaviorally, children are less proficient than adults at understanding speech-in-noise. Here, neuromagnetic signals were recorded while healthy adults and typically developing 6- to 9-year-old children attended to a speech stream embedded in a multitalker background noise with varying intensity. Results demonstrate that auditory cortices of both children and adults selectively track the attended speaker's voice rather than the global acoustic input at phrasal and word rates. However, increments of noise compromised the tracking significantly more in children than in adults. Unexpectedly, children displayed limited tracking of both the attended voice and the global acoustic input at the 4-8 Hz syllable rhythm. Thus, both speech-in-noise abilities and cortical tracking of speech syllable repetition rate seem to mature later in adolescence.

Left Superior Temporal Gyrus Is Coupled to Attended Speech in a Cocktail-Party Auditory Scene.

Using a continuous listening task, we evaluated the coupling between the listener's cortical activity and the temporal envelopes of different sounds in a multitalker auditory scene using magnetoencephalography and corticovocal coherence analysis. Neuromagnetic signals were recorded from 20 right-handed healthy adult humans who listened to five different recorded stories (attended speech streams), one without any multitalker background (No noise) and four mixed with a "cocktail party" multitalker background noise at four signal-to-noise ratios (5, 0, -5, and -10 dB) to produce speech-in-noise mixtures, here referred to as Global scene. Coherence analysis revealed that the modulations of the attended speech stream, presented without multitalker background, were coupled at ∼0.5 Hz to the activity of both superior temporal gyri, whereas the modulations at 4-8 Hz were coupled to the activity of the right supratemporal auditory cortex. In cocktail party conditions, with the multitalker background noise, the coupling was at both frequencies stronger for the attended speech stream than for the unattended Multitalker background. The coupling strengths decreased as the Multitalker background increased. During the cocktail party conditions, the ∼0.5 Hz coupling became left-hemisphere dominant, compared with bilateral coupling without the multitalker background, whereas the 4-8 Hz coupling remained right-hemisphere lateralized in both conditions. The brain activity was not coupled to the multitalker background or to its individual talkers. The results highlight the key role of listener's left superior temporal gyri in extracting the slow ∼0.5 Hz modulations, likely reflecting the attended speech stream within a multitalker auditory scene. SIGNIFICANCE STATEMENT: When people listen to one person in a "cocktail party," their auditory cortex mainly follows the attended speech stream rather than the entire auditory scene. However, how the brain extracts the attended speech stream from the whole auditory scene and how increasing background noise corrupts this process is still debated. In this magnetoencephalography study, subjects had to attend a speech stream with or without multitalker background noise. Results argue for frequency-dependent cortical tracking mechanisms for the attended speech stream. The left superior temporal gyrus tracked the ∼0.5 Hz modulations of the attended speech stream only when the speech was embedded in multitalker background, whereas the right supratemporal auditory cortex tracked 4-8 Hz modulations during both noiseless and cocktail-party conditions.

A case of lipoma arising in the eustachian tube.

We report a case of a lipoma inside the eustachian tube, an extremely rare location for this lesion. To the best of our knowledge, this is only the second such case that has been described in the literature. The patient was a 47-year-old man, a fighter pilot, who was referred to our hospital with a 3-year history of (1) fullness in the right ear secondary to recurrent serous otitis media and (2) right ear pain, which was especially acute during flights. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging detected the presence of a well-encapsulated lesion inside the eustachian tube; macroscopic and radiologic findings identified the mass as a lipoma. The lesion was completely removed via transnasal endoscopy. Histopathologic evaluation confirmed the diagnosis of lipoma. The patient's postoperative course was favorable, and he was able to fly again without any ear complaints. Radiologic examination is useful for the diagnosis and preoperative evaluation of this benign tumor. Lesions located in the lower part of the eustachian tube can be easily removed via a transnasal endoscopic approach.

Galectin-1, -3, -7 expressions in congenital and acquired pediatric cholesteatomas compared to external auditory canal skin.

OBJECTIVES: There is a classical distinction based on clinical criteria between acquired and congenital cholesteatomas. To determine if these two types of lesions show different immunohistochemical features, we have studied the expression patterns of three distinctive galectins (animal lectins implied especially in cellular proliferation and apoptosis) in both types of cholesteatomas and compared it to their expression patterns in external auditory canal skin. METHODS: Our study is based on nine acquired and eight congenital cholesteatomas, obtained from children during ear surgery. Six specimens of normal adult auditory meatal skin served as control. Specimens were analyzed by immunohistochemistry using monoclonal antibodies with galectin-1 and galectin-3, and a polyclonal antibody with galectin-7. RESULTS: We did not observe any differences in the galectin distribution pattern between congenital and acquired pediatric cholesteatomas. Compared to the control group, cholesteatomas present some particular features. There was no expression of galectin-1 and a lower expression of galectin-3 in the epithelium. Furthermore, we observed a preferentially nuclear distribution of galectin-7 in cholesteatomas, whereas it is essentially cytoplasmic in the control group. CONCLUSION: The data reported in this study suggest, on the basis of a lesser marked galectin-3 in cholesteatomas epithelium compared with an external auditory canal skin, that an immature keratinocytes population is at the origin of these lesions and that galectin-3 and galectin-7 play a part in the capacity as apoptosis modulators. Our study does not establish a difference in the galectin expressions of congenital and acquired cholesteatomas, but it constitutes however an additional argument in favor of the "undifferentiated" origin of keratinocytes in cholesteatomas.

Animal model for cholesteatoma induced in the gerbil: will the profiles of differentiation/growth-regulatory markers be similar to the clinical situation?

INTRODUCTION: Cholesteatoma is a benign tumor of the middle ear characterized by an aggressive and invasive potential. The only current treatment being surgery, it is important to have access to a reliable animal model to study and better understand cholesteatoma pathogenesis. Our study aimed to examine the biological validity of the most common experimental model of cholesteatoma: the Mongolian gerbil. MATERIAL AND METHODS: We have induced cholesteatoma by surgical ligature of the gerbil's external auditory duct. Quantitative comparison of eight biological markers involved in inflammation (macrophage migration inhibitory factor [MIF]), cell differentiation (retinoic acid receptors-alpha, -beta, and -gamma), and cell adhesion/apoptosis (galectins-1, -3, -7, and -8). The immunohistochemical staining was quantified by computer-assisted microscopy. RESULTS: Two immunohistochemical parameters were determined in sections. The labeling index (LI) represents the percentage of tissue area specifically stained, and the mean optical density (MOD) denotes the staining intensity index. The LI reveals statistically significant differences for each marker tested. The MOD also shows statistically significant differences except for MIF (P = .259). CONCLUSION: From the panel of markers, the majority of staining parameters was statistically significantly different between sections of the animal model and clinical specimen. These data do not support the concept of complete validity of the popular animal model.

Characterization of patterns of expression of protein kinase C-alpha, -delta, -eta, -gamma and -zeta and their correlations to p53, galectin-3, the retinoic acid receptor-beta and the macrophage migration inhibitory factor (MIF) in human cholesteatomas.

Cholesteatoma is a benign disease characterized by the presence of an unrestrained growth and the accumulation of keratin in the middle ear cavity. Due to roles in cell proliferation, apoptosis and differentiation members of the protein kinase C (PKC) family could be involved in disease progression. This study focuses on the expression of protein kinase C-alpha, -delta, -eta, -gamma and -zeta in the epithelial tissues of 56 human cholesteatomas and their correlations with those of previously characterized distributions of p53, galectin-3, retinoic acid receptor-beta (RARbeta) and macrophage migration inhibitory factor (MIF). We have previously reported this marker set to be correlated with keratinocyte differentiation in human cholesteatomas. Our present data clearly show that the percentage of PKC-alpha (but not PKC-delta, -gamma, -eta and -zeta)-immunopositive cells in epithelial tissue fro recurrent cholesteatomas was significantly higher than in non-recurrent cases. Correlations between the PKC isoenzymes and the biological markers were non-uniform. PKC-alpha (but not PKC-delta, -gamma, -eta and -zeta) expression in epithelial cholesteatoma cells correlated significantly and positively with the percentages of p53-immunopositive cells. The patterns of PKC-alpha and -delta expression, but not of PKC-gamma, -eta and -zeta, correlated significantly and positively with galectin-3 expression. In addition, the correlation levels between the expression of PKC-alpha and -delta and that of galectin-3 varied depending on the infection and recurrence status. Presence of RARbeta correlated significantly (and positively) with the expression of PKC-gamma and -zeta and also in relation to the infection and recurrence status. MIF correlated presence significantly (and positively) with that of the five PKCs under study, depending on whether the cholesteatomas were non-infected or infected as well as non-recurrent or recurrent. In conclusion, the present study suggests that modifications occurring at the level of keratinocyte differentiation in human cholesteatomas involve distinct effectors, to which the activation of PKC-alpha, -delta, -eta, -gamma and -zeta can be added.

Respiratory epithelial adenomatoid hamartoma associated with nasal polyposis.

Hamartoma is a rare, non-neoplastic tumor characterized by an abnormal mixture of tissues, which are indigenous to the region. They are rare in the nasal cavity. We report a 79-year-old woman with an adenomatoid hamartoma in the left nasal cavity associated with nasal polyposis. This association supports the hypothesis that inflammation is one of the factors that induce the development of a hamartoma. Functional endoscopic sinus surgery was performed to completely remove it, and this lesion was found to have arisen from the lateral nasal wall. It is an unusual localization because the most common site in the nasal cavity is the nasal septum, particularly the posterior aspect. Limited but complete surgical resection is the treatment of choice. Although adenomatoid hamartoma arising from the sinonasal tract is very rare, head and neck surgeons should be aware of this pathological entity as a differential diagnosis for inverted papilloma and adenocarcinoma. Misinterpretation of these lesions as a true neoplasm may result in unnecessarily aggressive surgery for this benign lesion.

Galectin-1 is overexpressed in nasal polyps under budesonide and inhibits eosinophil migration.

Because of the importance of galectins for various cellular activities, the influence of the glucocorticoid budesonide on the level of expression of galectins-1 and -3 was investigated in human nasal polyposis. Ten nasal polyps obtained from surgical resection were maintained for 24 hours in the presence of various concentrations of budesonide. As quantitatively demonstrated by means of computer-assisted microscopy, 250 ng/ml (the highest dose tested) induced a pronounced increase of galectin-1 expression. This feature was observed in nasal polyps from allergic patients but not in those from nonallergic patients. Since eosinophils represent the main inflammatory cell population in nasal polyps, we investigated the effect of galectin-1 on their migration levels by means of quantitative phase-contrast computer-assisted videomicroscopy. Our results show that galectin-1 (coated on plastic supports) markedly reduced the migration levels of eosinophils in comparison to P-selectin. On the cellular level, marked modifications in the polymerization/depolymerization dynamics of the actin cytoskeleton (as revealed by means of computer-assisted fluorescence microscopy) and, to a much lesser extent, an increase in the adhesiveness of eosinophils to tested substrata were detectable. The present study therefore reveals a new galectin-1-mediated mechanism of action for glucocorticoid-mediated anti-inflammatory effects.