Patient perspectives on the need for improved hearing rehabilitation: A qualitative survey study of German cochlear implant users.

Background: The electrical cochlear implant (eCI) partially restores hearing in individuals affected by profound hearing impairment (HI) or deafness. However, the limited resolution of sound frequency coding with eCIs limits hearing in daily situations such as group conversations. Current research promises future improvements in hearing restoration which may involve gene therapy and optical stimulation of the auditory nerve, using optogenetics. Prior to the potential clinical translation of these technologies, it is critical that patients are engaged in order to align future research agendas and technological advancements with their needs. Methods: Here, we performed a survey study with hearing impaired, using an eCI as a means of hearing rehabilitation. We distributed a questionnaire to 180 adult patients from the University Medical Center Göttingen's Department of Otolaryngology who were actively using an eCI for 6 months or more during the time of the survey period. Questions revolved around patients needs, and willingness to accept hypothetical risks or drawbacks associated with an optical CI (oCI). Results: Eighty-one participants responded to the questionnaire; 68% were greater than 60 years of age and 26% had bilateral eCIs. Participants expressed a need for improving the performance beyond that experienced with their current eCI. Primarily, they desired improved speech comprehension in background noise, greater ability to appreciate music, and more natural sound impression. They expressed a willingness for engaging with new technologies for improved hearing restoration. Notably, participants were least concerned about hypothetically receiving a gene therapy necessary for the oCI implant; but expressed greater reluctance to hypothetically receiving an implant that had yet to be evaluated in a human clinical trial. Conclusion: This work provides a preliminary step in engaging patients in the development of a new technology that has the potential to address the limitations of electrical hearing rehabilitation.

Is there an unmet medical need for improved hearing restoration?

Hearing impairment, the most prevalent sensory deficit, affects more than 466 million people worldwide (WHO). We presently lack causative treatment for the most common form, sensorineural hearing impairment; hearing aids and cochlear implants (CI) remain the only means of hearing restoration. We engaged with CI users to learn about their expectations and their willingness to collaborate with health care professionals on establishing novel therapies. We summarize upcoming CI innovations, gene therapies, and regenerative approaches and evaluate the chances for clinical translation of these novel strategies. We conclude that there remains an unmet medical need for improving hearing restoration and that we are likely to witness the clinical translation of gene therapy and major CI innovations within this decade.

Does airborne ultrasound lead to activation of the auditory cortex?

As airborne ultrasound can be found in many technical applications and everyday situations, the question as to whether sounds at these frequencies can be heard by human beings or whether they present a risk to their hearing system is of great practical relevance. To objectively study these issues, the monaural hearing threshold in the frequency range from 14 to 24 kHz was determined for 26 test subjects between 19 and 33 years of age using pure tone audiometry. The hearing threshold values increased strongly with increasing frequency up to around 21 kHz, followed by a range with a smaller slope toward 24 kHz. The number of subjects who could respond positively to the threshold measurements decreased dramatically above 21 kHz. Brain activation was then measured by means of magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) and with acoustic stimuli at the same frequencies, with sound pressure levels (SPLs) above and below the individual threshold. No auditory cortex activation was found for levels below the threshold. Although test subjects reported audible sounds above the threshold, no brain activity was identified in the above-threshold case under current experimental conditions except at the highest sensation level, which was presented at the lowest test frequency.

Altered cortical and subcortical connectivity due to infrasound administered near the hearing threshold - Evidence from fMRI.

In the present study, the brain's response towards near- and supra-threshold infrasound (IS) stimulation (sound frequency < 20 Hz) was investigated under resting-state fMRI conditions. The study involved two consecutive sessions. In the first session, 14 healthy participants underwent a hearing threshold-as well as a categorical loudness scaling measurement in which the individual loudness perception for IS was assessed across different sound pressure levels (SPL). In the second session, these participants underwent three resting-state acquisitions, one without auditory stimulation (no-tone), one with a monaurally presented 12-Hz IS tone (near-threshold) and one with a similar tone above the individual hearing threshold corresponding to a 'medium loud' hearing sensation (supra-threshold). Data analysis mainly focused on local connectivity measures by means of regional homogeneity (ReHo), but also involved independent component analysis (ICA) to investigate inter-regional connectivity. ReHo analysis revealed significantly higher local connectivity in right superior temporal gyrus (STG) adjacent to primary auditory cortex, in anterior cingulate cortex (ACC) and, when allowing smaller cluster sizes, also in the right amygdala (rAmyg) during the near-threshold, compared to both the supra-threshold and the no-tone condition. Additional independent component analysis (ICA) revealed large-scale changes of functional connectivity, reflected in a stronger activation of the right amygdala (rAmyg) in the opposite contrast (no-tone > near-threshold) as well as the right superior frontal gyrus (rSFG) during the near-threshold condition. In summary, this study is the first to demonstrate that infrasound near the hearing threshold may induce changes of neural activity across several brain regions, some of which are known to be involved in auditory processing, while others are regarded as keyplayers in emotional and autonomic control. These findings thus allow us to speculate on how continuous exposure to (sub-)liminal IS could exert a pathogenic influence on the organism, yet further (especially longitudinal) studies are required in order to substantialize these findings.

Brief bursts of infrasound may improve cognitive function--an fMRI study.

At present, infrasound (sound frequency < 20 Hz; IS) is being controversially discussed as a potential mediator of several adverse bodily as well as psychological effects. However, it remains unclear, if and in what way IS influences cognition. Here, we conducted an fMRI experiment, in which 13 healthy participants were exposed to IS, while cognitive performance was assessed in an n-back working memory paradigm. During the task, short sinusoidal tone bursts of 12 Hz were administered monaurally with sound pressure levels that had been determined individually in a categorical loudness scaling session prior to the fMRI experiment. We found that task execution was associated with a significant activation of the prefrontal and the parietal cortex, as well as the striatum and the cerebellum, indicating the recruitment of a cognitive control network. Reverse contrast analysis (n-back with tone vs. n-back without tone) revealed a significant activation of the bilateral primary auditory cortex (Brodmann areas 41, 42). Surprisingly, we also found a strong, yet non-significant trend for an improvement of task performance during IS exposure. There was no correlation between performance and brain activity measures in tone and no-tone condition with sum scores of depression-, anxiety-, and personality factor assessment scales (BDI, STAIX1/X2, BFI-S). Although exerting a pronounced effect on cortical brain activity, we obtained no evidence for an impairment of cognition due to brief bursts of IS. On the contrary, potential improvement of working memory function introduces an entirely new aspect to the debate on IS-related effects.