Effects of Unilateral Hearing Loss on Speech-Evoked Auditory Brainstem Responses and Reading: A Preliminary Study.

PURPOSE: The purpose of this study was to determine whether the speech-evoked auditory brainstem responses (sABRs) obtained by stimulating the ear with normal sensitivity in children with unilateral hearing loss (UHL) were different from that of children with normal hearing (NH), and to explore correlations between the sABR findings and measures of reading. METHOD: Eleven children with UHL and 11 children with NH were tested via the BioMARK sABR protocol using the syllable /da/; latency and amplitudes of Waves V, A, C, D, E, F, and O were measured. Participants also were tested on the Phonemic Synthesis Test (PST) and the Woodcock Reading Mastery Test-Revised (WRMT-R), particularly the Reading Readiness, Basic Skills, and Comprehension subtests. RESULTS: Multivariate analysis of variance testing showed a significantly higher amplitude for Wave A for the NH group as compared to the UHL group. Separate ANOVAs also found significantly lower scores for the UHL group compared to the NH group on Basic Skills and Comprehension subtests of the Woodcock. Significant positive Spearman rho correlations were found for the UHL group between wave amplitudes for V, A, and O and the Reading Readiness score, and between wave amplitudes for V, A, D, and O and the Reading Comprehension score. A significant correlation also was found between the Total Reading score and wave amplitudes for V and A. No such correlations were found between wave amplitude and Woodcock scores for the NH group. Further testing of the UHL data found significant relationships between the pure-tone average of the hearing loss ear and the Basic Skills, Comprehension, and Total Reading scores from the WRMT-R. There was also a significant correlation between the PST score and Wave C amplitude. CONCLUSION: There may be a connection between speech encoding and measures of reading in children with UHL.

Effects of Spectral Shaping on Speech Auditory Brainstem Responses to Stop Consonant-Vowel Syllables.

BACKGROUND: Spectral shaping is employed by hearing aids to make consonantal information, such as formant transitions, audible for listeners with hearing loss. How manipulations of the stimuli, such as spectral shaping, may alter encoding in the auditory brainstem has not been thoroughly studied. PURPOSE: The aim of this study was to determine how spectral shaping of synthetic consonant-vowel (CV) syllables, varying in their second formant (F2) onset frequency, may affect encoding of the syllables in the auditory brainstem. RESEARCH DESIGN: We employed a repeated measure design. STUDY SAMPLE: Sixteen young adults (mean = 20.94 years, 6 males) and 11 older adults (mean = 58.60 years, 4 males) participated in this study. DATA COLLECTION AND ANALYSIS: Speech-evoked auditory brainstem responses (speech-ABRs) were obtained from each participant using three CV exemplars selected from synthetic stimuli generated for a /ba-da-ga/ continuum. Brainstem responses were also recorded to corresponding three CV exemplars that were spectrally shaped to decrease low-frequency information and provide gain for middle and high frequencies according to a Desired Sensation Level function. In total, six grand average waveforms (3 phonemes [/ba/, /da/, /ga/] X 2 shaping conditions [unshaped, shaped]) were produced for each participant. Peak latencies and amplitudes, referenced to prestimulus baseline, were identified for 15 speech-ABR peaks. Peaks were marked manually using the program cursor on each individual waveform. Repeated-measures analysis of variances were used to determine the effects of shaping on the latencies and amplitudes of the speech-ABR peaks. RESULTS: Shaping effects produced changes within participants in ABR latencies and amplitudes involving onset and major peaks of the speech-ABR waveform for certain phonemes. Specifically, data from onset peaks showed that shaping decreased latency for /ga/ in older listeners, and decreased amplitude onset for /ba/ in younger listeners. Shaping also increased the amplitudes of major peaks for /ga/ stimuli in both groups. CONCLUSIONS: Encoding of speech in the ABR waveform may be more complex and multidimensional than a simple demarcation of source and filter information, and may also be influenced by cue intensity and age. These results suggest a more complex subcortical encoding of vocal tract filter information in the ABR waveform, which may also be influenced by cue intensity and age.

Click-evoked and speech-evoked auditory brainstem responses from individuals with multiple sclerosis.

PURPOSE: To determine whether speech-evoked auditory brainstem response (ABR) is more sensitive to the effects of multiple sclerosis (MS) than click-evoked ABR. MATERIALS AND METHODS: Eleven previously-confirmed MS patients (8 females, 3 males) and nine controls (7 females, 2 males), matched in age and gender, participated in a repeated-measures design. Stimuli were presented monaurally to the right ear via insert earphone. All evoked potential responses were collected by a single-channel montage where three electrodes were placed on the center of the head (Cz: non-inverting/ active), the ipsilateral earlobe (inverting/ reference) and the contralateral earlobe (ground). Rarefaction clicks of 0.1 ms duration were presented at rates of 13.30 and 91.1 clicks per second. Speech-evoked ABRs were obtained using the BioMARK software and the Bio-Logic Navigator PRO hardware. A synthesized /da/ syllable of 40-ms duration was presented via alternating polarity and at a rate of 10.9 stimuli per second. Stimuli were presented at 80 dB SPL. Speech-evoked ABR responses were obtained in quiet and in noise. RESULTS: Conventional click ABR responses were absent more often at high presentation rates in control subjects than in MS patients. Speech-evoked ABR peak amplitudes, wave E latency and VA complex slope variables separated the MS patients from controls. Group differences were also found in speech-evoked ABR response correlations in quiet versus noise conditions. CONCLUSIONS: The speech-evoked ABR is as or more sensitive to MS than conventional ABR measures without resort to simply noting missing peaks. Comparison of speech-evoked ABR responses in quiet and in noise highlight loss of neural synchrony in MS.

Effects of Aging on the Subcortical Encoding of Stop Consonants.

Purpose The main purpose of this study was to evaluate aging effects on the predominantly subcortical (brainstem) encoding of the second-formant frequency transition, an essential acoustic cue for perceiving place of articulation. Method Synthetic consonant-vowel syllables varying in second-formant onset frequency (i.e., /ba/, /da/, and /ga/ stimuli) were used to elicit speech-evoked auditory brainstem responses (speech-ABRs) in 16 young adults (M age = 21 years) and 11 older adults (M age = 59 years). Repeated-measures mixed-model analyses of variance were performed on the latencies and amplitudes of the speech-ABR peaks. Fixed factors were phoneme (repeated measures on three levels: /b/ vs. /d/ vs. /g/) and age (two levels: young vs. older). Results Speech-ABR differences were observed between the two groups (young vs. older adults). Specifically, older listeners showed generalized amplitude reductions for onset and major peaks. Significant Phoneme × Group interactions were not observed. Conclusions Results showed aging effects in speech-ABR amplitudes that may reflect diminished subcortical encoding of consonants in older listeners. These aging effects were not phoneme dependent as observed using the statistical methods of this study.

Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease.

Importance: The already large population of individuals with age- or noise-related hearing loss in the United States is increasing, yet hearing aids remain largely inaccessible. The recent decision by the US Food and Drug Administration to not enforce the medical examination prior to hearing aid fitting highlights the need to reengineer consumer protections when increasing accessibility. A self-administered tool to estimate ear disease risk would provide disease surveillance without posing an unreasonable barrier to hearing aid procurement. Objective: To develop and validate a consumer questionnaire for the self-assessment of risk for ear diseases associated with hearing loss. Design, Setting, and Participants: The questionnaire was developed using established methods including expert opinion to validate and create questions, and cognitive interviews to ensure that questions were clear to respondents. Exploratory structural equation modeling, logistic regression, and receiver operating characteristic curve analysis were used to determine sensitivity and specificity with blinded neurotologist opinion as the criterion for evaluation. Patients 40 to 80 years old with ear or hearing complaints necessitating a neurotologic examination and a control group of participants with a diagnosis of age- or noise-related hearing loss participated at the Departments of Otorhinolaryngology and Audiology of Mayo Clinic Florida. Main Outcomes and Measures: Sensitivity and specificity of the prototype questionnaire to identify individuals with targeted diseases. Results: Of 307 participants (mean [SD] age, 62.9 [9.8] years; 148 [48%] female), 75% (n = 231) were enrolled with targeted disease(s) identified on neurotologic assessment and 25% (n = 76) with age- or noise-related hearing loss. Participants were randomly divided into a training sample (80% [n = 246; 185 with disease, 61 controls]) and a test sample (20% [n = 61; 46 with disease, 15 controls]). Using a simple scoring method, a sensitivity of 94% (95% CI, 89%-97%) and specificity of 61% (95% CI, 47%-73%) were established in the training sample. Applying this cutoff to the test sample resulted in 85% (95% CI, 71%-93%) sensitivity and 47% (95% CI, 22%-73%) specificity. Conclusions and Relevance: This is the first self-assessment tool designed to assess an individual's risk for ear disease. Our preliminary results demonstrate a high sensitivity to disease detection. A further validated and refined version of this questionnaire may serve as an efficacious tool for improving access to hearing health care while minimizing the risk for missed ear diseases.

Neuromodulatory Effects of Auditory Training and Hearing Aid Use on Audiovisual Speech Perception in Elderly Individuals.

Although audiovisual (AV) training has been shown to improve overall speech perception in hearing-impaired listeners, there has been a lack of direct brain imaging data to help elucidate the neural networks and neural plasticity associated with hearing aid (HA) use and auditory training targeting speechreading. For this purpose, the current clinical case study reports functional magnetic resonance imaging (fMRI) data from two hearing-impaired patients who were first-time HA users. During the study period, both patients used HAs for 8 weeks; only one received a training program named ReadMyQuipsTM (RMQ) targeting speechreading during the second half of the study period for 4 weeks. Identical fMRI tests were administered at pre-fitting and at the end of the 8 weeks. Regions of interest (ROI) including auditory cortex and visual cortex for uni-sensory processing, and superior temporal sulcus (STS) for AV integration, were identified for each person through independent functional localizer task. The results showed experience-dependent changes involving ROIs of auditory cortex, STS and functional connectivity between uni-sensory ROIs and STS from pretest to posttest in both cases. These data provide initial evidence for the malleable experience-driven cortical functionality for AV speech perception in elderly hearing-impaired people and call for further studies with a much larger subject sample and systematic control to fill in the knowledge gap to understand brain plasticity associated with auditory rehabilitation in the aging population.

Neural Correlates of Selective Attention With Hearing Aid Use Followed by ReadMyQuips Auditory Training Program.

OBJECTIVES: The objectives of this study were to investigate the effects of hearing aid use and the effectiveness of ReadMyQuips (RMQ), an auditory training program, on speech perception performance and auditory selective attention using electrophysiological measures. RMQ is an audiovisual training program designed to improve speech perception in everyday noisy listening environments. DESIGN: Participants were adults with mild to moderate hearing loss who were first-time hearing aid users. After 4 weeks of hearing aid use, the experimental group completed RMQ training in 4 weeks, and the control group received listening practice on audiobooks during the same period. Cortical late event-related potentials (ERPs) and the Hearing in Noise Test (HINT) were administered at prefitting, pretraining, and post-training to assess effects of hearing aid use and RMQ training. An oddball paradigm allowed tracking of changes in P3a and P3b ERPs to distractors and targets, respectively. Behavioral measures were also obtained while ERPs were recorded from participants. RESULTS: After 4 weeks of hearing aid use but before auditory training, HINT results did not show a statistically significant change, but there was a significant P3a reduction. This reduction in P3a was correlated with improvement in d prime (d') in the selective attention task. Increased P3b amplitudes were also correlated with improvement in d' in the selective attention task. After training, this correlation between P3b and d' remained in the experimental group, but not in the control group. Similarly, HINT testing showed improved speech perception post training only in the experimental group. The criterion calculated in the auditory selective attention task showed a reduction only in the experimental group after training. ERP measures in the auditory selective attention task did not show any changes related to training. CONCLUSIONS: Hearing aid use was associated with a decrement in involuntary attention switch to distractors in the auditory selective attention task. RMQ training led to gains in speech perception in noise and improved listener confidence in the auditory selective attention task.

Can a Commercially Available Auditory Training Program Improve Audiovisual Speech Performance?

PURPOSE: The goal of this study was to determine whether hearing aids in combination with computer-based auditory training improve audiovisual (AV) performance compared with the use of hearing aids alone. METHOD: Twenty-four participants were randomized into an experimental group (hearing aids plus ReadMyQuips [RMQ] training) and a control group (hearing aids only). The Multimodal Lexical Sentence Test for Adults (Kirk et al., 2012) was used to measure auditory-only (AO) and AV speech perception performance at three signal-to-noise ratios (SNRs). Participants were tested at the time of hearing aid fitting (pretest), after 4 weeks of hearing aid use (posttest I), and again after 4 weeks of RMQ training (posttest II). RESULTS: Results did not reveal an effect of training. As expected, interactions were found between (a) modality (AO vs. AV) and SNR and (b) test (pretest vs. posttests) and SNR. CONCLUSION: Data do not show a significant effect of RMQ training on AO or AV performance as measured using the Multimodal Lexical Sentence Test for Adults.

Acceptable noise level and psychophysical masking.

PURPOSE: Individuals with low acceptable noise levels (ANLs) accept more noise than individuals with high ANLs. To determine whether ANL is influenced more by afferent or efferent cortical responsiveness, the authors measured differences in temporal masking responses between individuals with low versus high ANLs. If listeners with low ANLs have masked thresholds similar to those of listeners with high ANLs, low ANLs may be due to reduced afferent responsiveness affecting both the masker and signal. If, however, listeners with low ANLs have masked thresholds better than that of listeners with high ANLs, there may be a physiological basis for improved selective attention via stronger efferent inhibition of the "unwanted" sound. METHOD: Participants were 19 listeners with normal hearing between the ages of 19 and 35. Ten listeners had low ANLs and 9 had high ANLs. All participants were compared using tone-in-noise simultaneous, forward, and backward masking tasks. RESULTS: Results revealed no observed differences in masked thresholds between the low versus high ANL group. The low ANL group, however, required significantly more threshold runs to achieve criterion necessary for threshold determinations. CONCLUSIONS: Findings suggest that low ANLs are associated with reduced afferent cortical responsiveness and, possibly, decreased sustained attention.