Changes in visually and auditory attended audiovisual speech processing in cochlear implant users: A longitudinal ERP study.

Limited auditory input, whether caused by hearing loss or by electrical stimulation through a cochlear implant (CI), can be compensated by the remaining senses. Specifically for CI users, previous studies reported not only improved visual skills, but also altered cortical processing of unisensory visual and auditory stimuli. However, in multisensory scenarios, it is still unclear how auditory deprivation (before implantation) and electrical hearing experience (after implantation) affect cortical audiovisual speech processing. Here, we present a prospective longitudinal electroencephalography (EEG) study which systematically examined the deprivation- and CI-induced alterations of cortical processing of audiovisual words by comparing event-related potentials (ERPs) in postlingually deafened CI users before and after implantation (five weeks and six months of CI use). A group of matched normal-hearing (NH) listeners served as controls. The participants performed a word-identification task with congruent and incongruent audiovisual words, focusing their attention on either the visual (lip movement) or the auditory speech signal. This allowed us to study the (top-down) attention effect on the (bottom-up) sensory cortical processing of audiovisual speech. When compared to the NH listeners, the CI candidates (before implantation) and the CI users (after implantation) exhibited enhanced lipreading abilities and an altered cortical response at the N1 latency range (90-150 ms) that was characterized by a decreased theta oscillation power (4-8 Hz) and a smaller amplitude in the auditory cortex. After implantation, however, the auditory-cortex response gradually increased and developed a stronger intra-modal connectivity. Nevertheless, task efficiency and activation in the visual cortex was significantly modulated in both groups by focusing attention on the visual as compared to the auditory speech signal, with the NH listeners additionally showing an attention-dependent decrease in beta oscillation power (13-30 Hz). In sum, these results suggest remarkable deprivation effects on audiovisual speech processing in the auditory cortex, which partially reverse after implantation. Although even experienced CI users still show distinct audiovisual speech processing compared to NH listeners, pronounced effects of (top-down) direction of attention on (bottom-up) audiovisual processing can be observed in both groups. However, NH listeners but not CI users appear to show enhanced allocation of cognitive resources in visually as compared to auditory attended audiovisual speech conditions, which supports our behavioural observations of poorer lipreading abilities and reduced visual influence on audition in NH listeners as compared to CI users.

The Right-Ear Advantage in Static and Dynamic Cocktail-Party Situations.

When presenting two competing speech stimuli, one to each ear, a right-ear advantage (REA) can often be observed, reflected in better speech recognition compared to the left ear. Considering the left-hemispheric dominance for language, the REA has been explained by superior contralateral pathways (structural models) and language-induced shifts of attention to the right (attentional models). There is some evidence that the REA becomes more pronounced, as cognitive load increases. Hence, it is interesting to investigate the REA in static (constant target talker) and dynamic (target changing pseudo-randomly) cocktail-party situations, as the latter is associated with a higher cognitive load than the former. Furthermore, previous research suggests an increasing REA, when listening becomes more perceptually challenging. The present study examined the REA by using virtual acoustics to simulate static and dynamic cocktail-party situations, with three spatially separated talkers uttering concurrent matrix sentences. Sentences were presented at low sound pressure levels or processed with a noise vocoder to increase perceptual load. Sixteen young normal-hearing adults participated in the study. The REA was assessed by means of word recognition scores and a detailed error analysis. Word recognition revealed a greater REA for the dynamic than for the static situations, compatible with the view that an increase in cognitive load results in a heightened REA. Also, the REA depended on the type of perceptual load, as indicated by a higher REA associated with vocoded compared to low-level stimuli. The results of the error analysis support both structural and attentional models of the REA.

Effects of noise and noise reduction on audiovisual speech perception in cochlear implant users: An ERP study.

OBJECTIVE: Hearing with a cochlear implant (CI) is difficult in noisy environments, but the use of noise reduction algorithms, specifically ForwardFocus, can improve speech intelligibility. The current event-related potentials (ERP) study examined the electrophysiological correlates of this perceptual improvement. METHODS: Ten bimodal CI users performed a syllable-identification task in auditory and audiovisual conditions, with syllables presented from the front and stationary noise presented from the sides. Brainstorm was used for spatio-temporal evaluation of ERPs. RESULTS: CI users revealed an audiovisual benefit as reflected by shorter response times and greater activation in temporal and occipital regions at P2 latency. However, in auditory and audiovisual conditions, background noise hampered speech processing, leading to longer response times and delayed auditory-cortex-activation at N1 latency. Nevertheless, activating ForwardFocus resulted in shorter response times, reduced listening effort and enhanced superior-frontal-cortex-activation at P2 latency, particularly in audiovisual conditions. CONCLUSIONS: ForwardFocus enhances speech intelligibility in audiovisual speech conditions by potentially allowing the reallocation of attentional resources to relevant auditory speech cues. SIGNIFICANCE: This study shows for CI users that background noise and ForwardFocus differentially affect spatio-temporal cortical response patterns, both in auditory and audiovisual speech conditions.

Electrophysiological differences and similarities in audiovisual speech processing in CI users with unilateral and bilateral hearing loss.

Hearing with a cochlear implant (CI) is limited compared to natural hearing. Although CI users may develop compensatory strategies, it is currently unknown whether these extend from auditory to visual functions, and whether compensatory strategies vary between different CI user groups. To better understand the experience-dependent contributions to multisensory plasticity in audiovisual speech perception, the current event-related potential (ERP) study presented syllables in auditory, visual, and audiovisual conditions to CI users with unilateral or bilateral hearing loss, as well as to normal-hearing (NH) controls. Behavioural results revealed shorter audiovisual response times compared to unisensory conditions for all groups. Multisensory integration was confirmed by electrical neuroimaging, including topographic and ERP source analysis, showing a visual modulation of the auditory-cortex response at N1 and P2 latency. However, CI users with bilateral hearing loss showed a distinct pattern of N1 topography, indicating a stronger visual impact on auditory speech processing compared to CI users with unilateral hearing loss and NH listeners. Furthermore, both CI user groups showed a delayed auditory-cortex activation and an additional recruitment of the visual cortex, and a better lip-reading ability compared to NH listeners. In sum, these results extend previous findings by showing distinct multisensory processes not only between NH listeners and CI users in general, but even between CI users with unilateral and bilateral hearing loss. However, the comparably enhanced lip-reading ability and visual-cortex activation in both CI user groups suggest that these visual improvements are evident regardless of the hearing status of the contralateral ear.

Side-of-Implantation Effect on Functional Asymmetry in the Auditory Cortex of Single-Sided Deaf Cochlear-Implant Users.

Cochlear implants (CIs) allow to restore the hearing function in profoundly deaf individuals. Due to the degradation of the stimulus by CI signal processing, implanted individuals with single-sided deafness (SSD) have the specific challenge that the input highly differs between their ears. The present study compared normal-hearing (NH) listeners (N = 10) and left- and right-ear implanted SSD CI users (N = 10 left, N = 9 right), to evaluate cortical speech processing between CI- and NH-ears and to explore for side-of-implantation effects. The participants performed a two-deviant oddball task, separately with the left and the right ear. Auditory event-related potentials (ERPs) in response to syllables were compared between proficient and non-proficient CI users, as well as between CI and NH ears. The effect of the side of implantation was analysed on the sensor and the source level. CI proficiency could be distinguished based on the ERP amplitudes of the N1 and the P3b. Moreover, syllable processing via the CI ear, when compared to the NH ear, resulted in attenuated and delayed ERPs. In addition, the left-ear implanted SSD CI users revealed an enhanced functional asymmetry in the auditory cortex than right-ear implanted SSD CI users, regardless of whether the syllables were perceived via the CI or the NH ear. Our findings reveal that speech-discrimination proficiency in SSD CI users can be assessed by N1 and P3b ERPs. The results contribute to a better understanding of the rehabilitation success in SSD CI users by showing that cortical speech processing in SSD CI users is affected by CI-related stimulus degradation and experience-related functional changes in the auditory cortex.

The timecourse of multisensory speech processing in unilaterally stimulated cochlear implant users revealed by ERPs.

A cochlear implant (CI) is an auditory prosthesis which can partially restore the auditory function in patients with severe to profound hearing loss. However, this bionic device provides only limited auditory information, and CI patients may compensate for this limitation by means of a stronger interaction between the auditory and visual system. To better understand the electrophysiological correlates of audiovisual speech perception, the present study used electroencephalography (EEG) and a redundant target paradigm. Postlingually deafened CI users and normal-hearing (NH) listeners were compared in auditory, visual and audiovisual speech conditions. The behavioural results revealed multisensory integration for both groups, as indicated by shortened response times for the audiovisual as compared to the two unisensory conditions. The analysis of the N1 and P2 event-related potentials (ERPs), including topographic and source analyses, confirmed a multisensory effect for both groups and showed a cortical auditory response which was modulated by the simultaneous processing of the visual stimulus. Nevertheless, the CI users in particular revealed a distinct pattern of N1 topography, pointing to a strong visual impact on auditory speech processing. Apart from these condition effects, the results revealed ERP differences between CI users and NH listeners, not only in N1/P2 ERP topographies, but also in the cortical source configuration. When compared to the NH listeners, the CI users showed an additional activation in the visual cortex at N1 latency, which was positively correlated with CI experience, and a delayed auditory-cortex activation with a reversed, rightward functional lateralisation. In sum, our behavioural and ERP findings demonstrate a clear audiovisual benefit for both groups, and a CI-specific alteration in cortical activation at N1 latency when auditory and visual input is combined. These cortical alterations may reflect a compensatory strategy to overcome the limited CI input, which allows the CI users to improve the lip-reading skills and to approximate the behavioural performance of NH listeners in audiovisual speech conditions. Our results are clinically relevant, as they highlight the importance of assessing the CI outcome not only in auditory-only, but also in audiovisual speech conditions.

Distinct multisensory perceptual processes guide enhanced auditory recognition memory in older cochlear implant users.

In naturalistic situations, sounds are often perceived in conjunction with matching visual impressions. For example, we see and hear the neighbor's dog barking in the garden. Still, there is a good chance that we recognize the neighbor's dog even when we only hear it barking, but do not see it behind the fence. Previous studies with normal-hearing (NH) listeners have shown that the audio-visual presentation of a perceptual object (like an animal) increases the probability to recognize this object later on, even if the repeated presentation of this object occurs in a purely auditory condition. In patients with a cochlear implant (CI), however, the electrical hearing of sounds is impoverished, and the ability to recognize perceptual objects in auditory conditions is significantly limited. It is currently not well understood whether CI users - as NH listeners - show a multisensory facilitation for auditory recognition. The present study used event-related potentials (ERPs) and a continuous recognition paradigm with auditory and audio-visual stimuli to test the prediction that CI users show a benefit from audio-visual perception. Indeed, the congruent audio-visual context resulted in an improved recognition ability of objects in an auditory-only condition, both in the NH listeners and the CI users. The ERPs revealed a group-specific pattern of voltage topographies and correlations between these ERP maps and the auditory recognition ability, indicating a different processing of congruent audio-visual stimuli in CI users when compared to NH listeners. Taken together, our results point to distinct cortical processing of naturalistic audio-visual objects in CI users and NH listeners, which however allows both groups to improve the recognition ability of these objects in a purely auditory context. Our findings are of relevance for future clinical research since audio-visual perception might also improve the auditory rehabilitation after cochlear implantation.

Age effects on cognitive functions and speech-in-noise processing: An event-related potential study with cochlear-implant users and normal-hearing listeners.

A cochlear implant (CI) can partially restore hearing in individuals with profound sensorineural hearing loss. However, electrical hearing with a CI is limited and highly variable. The current study aimed to better understand the different factors contributing to this variability by examining how age affects cognitive functions and cortical speech processing in CI users. Electroencephalography (EEG) was applied while two groups of CI users (young and elderly; N = 13 each) and normal-hearing (NH) listeners (young and elderly; N = 13 each) performed an auditory sentence categorization task, including semantically correct and incorrect sentences presented either with or without background noise. Event-related potentials (ERPs) representing earlier, sensory-driven processes (N1-P2 complex to sentence onset) and later, cognitive-linguistic integration processes (N400 to semantically correct/incorrect sentence-final words) were compared between the different groups and speech conditions. The results revealed reduced amplitudes and prolonged latencies of auditory ERPs in CI users compared to NH listeners, both at earlier (N1, P2) and later processing stages (N400 effect). In addition to this hearing-group effect, CI users and NH listeners showed a comparable background-noise effect, as indicated by reduced hit rates and reduced (P2) and delayed (N1/P2) ERPs in conditions with background noise. Moreover, we observed an age effect in CI users and NH listeners, with young individuals showing improved specific cognitive functions (working memory capacity, cognitive flexibility and verbal learning/retrieval), reduced latencies (N1/P2), decreased N1 amplitudes and an increased N400 effect when compared to the elderly. In sum, our findings extend previous research by showing that the CI users' speech processing is impaired not only at earlier (sensory) but also at later (semantic integration) processing stages, both in conditions with and without background noise. Using objective ERP measures, our study provides further evidence of strong age effects on cortical speech processing, which can be observed in both the NH listeners and the CI users. We conclude that elderly individuals require more effortful processing at sensory stages of speech processing, which however seems to be at the cost of the limited resources available for the later semantic integration processes.

Combined Brain-Perfusion SPECT and EEG Measurements Suggest Distinct Strategies for Speech Comprehension in CI Users With Higher and Lower Performance.

Cochlear implantation constitutes a successful therapy of inner ear deafness, with the majority of patients showing good outcomes. There is, however, still some unexplained variability in outcomes with a number of cochlear-implant (CI) users, showing major limitations in speech comprehension. The current study used a multimodal diagnostic approach combining single-photon emission computed tomography (SPECT) and electroencephalography (EEG) to examine the mechanisms underlying speech processing in postlingually deafened CI users (N = 21). In one session, the participants performed a speech discrimination task, during which a 96-channel EEG was recorded and the perfusions marker 99mTc-HMPAO was injected intravenously. The SPECT scan was acquired 1.5 h after injection to measure the cortical activity during the speech task. The second session included a SPECT scan after injection without stimulation at rest. Analysis of EEG and SPECT data showed N400 and P600 event-related potentials (ERPs) particularly evoked by semantic violations in the sentences, and enhanced perfusion in a temporo-frontal network during task compared to rest, involving the auditory cortex bilaterally and Broca's area. Moreover, higher performance in testing for word recognition and verbal intelligence strongly correlated to the activation in this network during the speech task. However, comparing CI users with lower and higher speech intelligibility [median split with cutoff + 7.6 dB signal-to-noise ratio (SNR) in the Göttinger sentence test] revealed for CI users with higher performance additional activations of parietal and occipital regions and for those with lower performance stronger activation of superior frontal areas. Furthermore, SPECT activity was tightly coupled with EEG and cognitive abilities, as indicated by correlations between (1) cortical activation and the amplitudes in EEG, N400 (temporal and occipital areas)/P600 (parietal and occipital areas) and (2) between cortical activation in left-sided temporal and bilateral occipital/parietal areas and working memory capacity. These results suggest the recruitment of a temporo-frontal network in CI users during speech processing and a close connection between ERP effects and cortical activation in CI users. The observed differences in speech-evoked cortical activation patterns for CI users with higher and lower speech intelligibility suggest distinct processing strategies during speech rehabilitation with CI.

Neuronal activation in the human centromedian-parafascicular complex predicts cortical responses to behaviorally significant auditory events.

Studies with non-human primates have suggested an excitatory influence of the thalamus on the cerebral cortex, with the centromedian-parafascicular complex (CM-Pf) being particularly involved in processes of sensory event-driven attention and arousal. To define the involvement of the human CM-Pf in bottom-up and top-down auditory attention, we simultaneously recorded cortical EEG activity and intracranial local field potentials (LFPs) via electrodes implanted for deep brain stimulation for the treatment of neuropathic pain. The patients (N â€‹= â€‹6) performed an auditory three-class oddball paradigm with frequent standard stimuli and two types of infrequent deviant stimuli (target and distractor). We found a parietal P3b to targets and a central P3a to distractors at the scalp level. Subcortical recordings in the CM-Pf revealed enhanced activation to targets compared to standards. Interarea-correlation analyses showed that activation in the CM-Pf predicted the generation of longer latency P3b scalp potentials specifically in the target condition. Our results provide first direct human evidence for a functional temporal relationship between target-related activation in the CM-Pf and an enhanced cortical target response. These results corroborate the hypothetical model of a cortico-basal ganglia loop system that switches from top-down to bottom-up mode in response to salient, task-relevant external events that are not predictable.

Thalamic and basal ganglia regions are involved in attentional processing of behaviorally significant events: evidence from simultaneous depth and scalp EEG.

Extensive descriptions exist on cortical responses to change in the acoustic environment. However, the involvement of subcortical regions is not well understood. Here we present simultaneous recordings of cortical and subcortical event-related potentials (ERPs) to different pure tones in patients undergoing surgery for deep brain stimulation (DBS). These patients had externalized electrodes in the subthalamic nucleus (STN), the ventrolateral posterior thalamus (VLp) or the globus pallidus internus (GPi). Subcortical and cortical ERPs were analyzed upon presentation of one frequent non-target stimulus and two infrequent stimuli, either being a target or a distractor stimulus. The results revealed that amplitudes of scalp-recorded P3 and subcortical late attention-modulated responses (AMR) were largest upon presentation of target stimuli compared with distractor stimuli. This suggests that thalamic and basal ganglia regions are sensitive to behaviorally relevant auditory events. Comparison of the subcortical structures showed that responses in VLp have shorter latency than in GPi and STN. Further, the subcortical responses in VLp and STN emerged significantly prior to the cortical P3 response. Our findings point to higher-order cognitive functions already at a subcortical level. Auditory events are categorized as behaviorally relevant in subcortical loops involving basal ganglia and thalamic regions. This label is then distributed to cortical regions by ascending projections.

Maturation of auditory brainstem responses in young children with congenital monaural atresia.

OBJECTIVE: To date, the impact of conductive hearing loss on the auditory pathway at brainstem level has only been investigated in animal studies, which showed a species-specific delay of maturation. In this study, the functional maturation of auditory brainstem response (ABR) parameters in humans with unilateral atresia of the external auditory canal was investigated. METHODS: 42 newborns and toddlers ranging in age from 13 days to 11 months were included. The click-evoked ABR interpeak latencies (IPL) of the atretic ears and the contralateral ears with normal hearing were evaluated. The children had no comorbidities and had never been fitted with any kind of hearing aid. The absolute latencies (AL) and IPL of a matched control group were compared to the contralateral normally hearing ears of the children with unilateral atresia. RESULTS: The mean air-bone gap in the ears with atresia was 44 dB HL. Despite this partial acoustic deprivation, no significant difference between the IPLs of normal ears and ears with atresia could be detected. Both for AL and IPL, the differences between the normal ears and the control group were all within 1 standard deviation to the mean. CONCLUSION: The data showed that the monaural acoustic deprivation by a block of sound conduction does not produce any delay of functional maturation at brainstem level in this group of patients. With regard to the AL and IPL on brainstem level, no differences between the normal ears of children with unilateral atresia and children with bilateral normal hearing could be detected.

Human centromedian-parafascicular complex signals sensory cues for goal-oriented behavior selection.

Experimental research has shown that the centromedian-parafascicular complex (CM-Pf) of the intralaminar thalamus is activated in attentional orienting and processing of behaviorally relevant stimuli. These observations resulted in the hypothesis that the CM-Pf plays a pivotal role in goal-oriented behavior selection. We here set out to test this hypothesis with electrophysiological recordings from patients with electrodes implanted in CM-Pf for deep brain stimulation (DBS) treatment of chronic neuropathic pain. Six patients participated in (1) an auditory three-class oddball experiment, which required a button press to target tones, but not to standard and deviant tones and in (2) a multi-speaker experiment with a target word that required attention selection and a target image that required response selection. Subjects showed transient neural responses (8-15Hz) to the target tone and the target word. Two subjects additionally showed transient neural responses (15-25Hz) to the target image. All sensory target stimuli were related to an internal goal and required a behavior selection (attention selection, response selection). In group analyses, neural responses were greater to target tones than deviant and standard tones and to target words than other task-relevant words that did not require attention selection. The transient neural responses occurred after the target stimuli but prior to the overt behavioral response. Our results demonstrate that in human subjects the CM-Pf is involved in signaling sensory inputs related to goal-oriented selection of behavior.

Auditory and audio-visual processing in patients with cochlear, auditory brainstem, and auditory midbrain implants: An EEG study.

There is substantial variability in speech recognition ability across patients with cochlear implants (CIs), auditory brainstem implants (ABIs), and auditory midbrain implants (AMIs). To better understand how this variability is related to central processing differences, the current electroencephalography (EEG) study compared hearing abilities and auditory-cortex activation in patients with electrical stimulation at different sites of the auditory pathway. Three different groups of patients with auditory implants (Hannover Medical School; ABI: n = 6, CI: n = 6; AMI: n = 2) performed a speeded response task and a speech recognition test with auditory, visual, and audio-visual stimuli. Behavioral performance and cortical processing of auditory and audio-visual stimuli were compared between groups. ABI and AMI patients showed prolonged response times on auditory and audio-visual stimuli compared with NH listeners and CI patients. This was confirmed by prolonged N1 latencies and reduced N1 amplitudes in ABI and AMI patients. However, patients with central auditory implants showed a remarkable gain in performance when visual and auditory input was combined, in both speech and non-speech conditions, which was reflected by a strong visual modulation of auditory-cortex activation in these individuals. In sum, the results suggest that the behavioral improvement for audio-visual conditions in central auditory implant patients is based on enhanced audio-visual interactions in the auditory cortex. Their findings may provide important implications for the optimization of electrical stimulation and rehabilitation strategies in patients with central auditory prostheses. Hum Brain Mapp 38:2206-2225, 2017. © 2017 Wiley Periodicals, Inc.

Consequences of Stimulus Type on Higher-Order Processing in Single-Sided Deaf Cochlear Implant Users.

Single-sided deaf subjects with a cochlear implant (CI) provide the unique opportunity to compare central auditory processing of the electrical input (CI ear) and the acoustic input (normal-hearing, NH, ear) within the same individual. In these individuals, sensory processing differs between their two ears, while cognitive abilities are the same irrespectively of the sensory input. To better understand perceptual-cognitive factors modulating speech intelligibility with a CI, this electroencephalography study examined the central-auditory processing of words, the cognitive abilities, and the speech intelligibility in 10 postlingually single-sided deaf CI users. We found lower hit rates and prolonged response times for word classification during an oddball task for the CI ear when compared with the NH ear. Also, event-related potentials reflecting sensory (N1) and higher-order processing (N2/N4) were prolonged for word classification (targets versus nontargets) with the CI ear compared with the NH ear. Our results suggest that speech processing via the CI ear and the NH ear differs both at sensory (N1) and cognitive (N2/N4) processing stages, thereby affecting the behavioral performance for speech discrimination. These results provide objective evidence for cognition to be a key factor for speech perception under adverse listening conditions, such as the degraded speech signal provided from the CI.

On the relationship between auditory cognition and speech intelligibility in cochlear implant users: An ERP study.

There is a high degree of variability in speech intelligibility outcomes across cochlear-implant (CI) users. To better understand how auditory cognition affects speech intelligibility with the CI, we performed an electroencephalography study in which we examined the relationship between central auditory processing, cognitive abilities, and speech intelligibility. Postlingually deafened CI users (N=13) and matched normal-hearing (NH) listeners (N=13) performed an oddball task with words presented in different background conditions (quiet, stationary noise, modulated noise). Participants had to categorize words as living (targets) or non-living entities (standards). We also assessed participants' working memory (WM) capacity and verbal abilities. For the oddball task, we found lower hit rates and prolonged response times in CI users when compared with NH listeners. Noise-related prolongation of the N1 amplitude was found for all participants. Further, we observed group-specific modulation effects of event-related potentials (ERPs) as a function of background noise. While NH listeners showed stronger noise-related modulation of the N1 latency, CI users revealed enhanced modulation effects of the N2/N4 latency. In general, higher-order processing (N2/N4, P3) was prolonged in CI users in all background conditions when compared with NH listeners. Longer N2/N4 latency in CI users suggests that these individuals have difficulties to map acoustic-phonetic features to lexical representations. These difficulties seem to be increased for speech-in-noise conditions when compared with speech in quiet background. Correlation analyses showed that shorter ERP latencies were related to enhanced speech intelligibility (N1, N2/N4), better lexical fluency (N1), and lower ratings of listening effort (N2/N4) in CI users. In sum, our findings suggest that CI users and NH listeners differ with regards to both the sensory and the higher-order processing of speech in quiet as well as in noisy background conditions. Our results also revealed that verbal abilities are related to speech processing and speech intelligibility in CI users, confirming the view that auditory cognition plays an important role for CI outcome. We conclude that differences in auditory-cognitive processing contribute to the variability in speech performance outcomes observed in CI users.

Cross-Modal Functional Reorganization of Visual and Auditory Cortex in Adult Cochlear Implant Users Identified with fNIRS.

Cochlear implant (CI) users show higher auditory-evoked activations in visual cortex and higher visual-evoked activation in auditory cortex compared to normal hearing (NH) controls, reflecting functional reorganization of both visual and auditory modalities. Visual-evoked activation in auditory cortex is a maladaptive functional reorganization whereas auditory-evoked activation in visual cortex is beneficial for speech recognition in CI users. We investigated their joint influence on CI users' speech recognition, by testing 20 postlingually deafened CI users and 20 NH controls with functional near-infrared spectroscopy (fNIRS). Optodes were placed over occipital and temporal areas to measure visual and auditory responses when presenting visual checkerboard and auditory word stimuli. Higher cross-modal activations were confirmed in both auditory and visual cortex for CI users compared to NH controls, demonstrating that functional reorganization of both auditory and visual cortex can be identified with fNIRS. Additionally, the combined reorganization of auditory and visual cortex was found to be associated with speech recognition performance. Speech performance was good as long as the beneficial auditory-evoked activation in visual cortex was higher than the visual-evoked activation in the auditory cortex. These results indicate the importance of considering cross-modal activations in both visual and auditory cortex for potential clinical outcome estimation.

Enhanced audio-visual interactions in the auditory cortex of elderly cochlear-implant users.

Auditory deprivation and the restoration of hearing via a cochlear implant (CI) can induce functional plasticity in auditory cortical areas. How these plastic changes affect the ability to integrate combined auditory (A) and visual (V) information is not yet well understood. In the present study, we used electroencephalography (EEG) to examine whether age, temporary deafness and altered sensory experience with a CI can affect audio-visual (AV) interactions in post-lingually deafened CI users. Young and elderly CI users and age-matched NH listeners performed a speeded response task on basic auditory, visual and audio-visual stimuli. Regarding the behavioral results, a redundant signals effect, that is, faster response times to cross-modal (AV) than to both of the two modality-specific stimuli (A, V), was revealed for all groups of participants. Moreover, in all four groups, we found evidence for audio-visual integration. Regarding event-related responses (ERPs), we observed a more pronounced visual modulation of the cortical auditory response at N1 latency (approximately 100 ms after stimulus onset) in the elderly CI users when compared with young CI users and elderly NH listeners. Thus, elderly CI users showed enhanced audio-visual binding which may be a consequence of compensatory strategies developed due to temporary deafness and/or degraded sensory input after implantation. These results indicate that the combination of aging, sensory deprivation and CI facilitates the coupling between the auditory and the visual modality. We suggest that this enhancement in multisensory interactions could be used to optimize auditory rehabilitation, especially in elderly CI users, by the application of strong audio-visually based rehabilitation strategies after implant switch-on.

Cross-modal reorganization in cochlear implant users: Auditory cortex contributes to visual face processing.

There is converging evidence that the auditory cortex takes over visual functions during a period of auditory deprivation. A residual pattern of cross-modal take-over may prevent the auditory cortex to adapt to restored sensory input as delivered by a cochlear implant (CI) and limit speech intelligibility with a CI. The aim of the present study was to investigate whether visual face processing in CI users activates auditory cortex and whether this has adaptive or maladaptive consequences. High-density electroencephalogram data were recorded from CI users (n=21) and age-matched normal hearing controls (n=21) performing a face versus house discrimination task. Lip reading and face recognition abilities were measured as well as speech intelligibility. Evaluation of event-related potential (ERP) topographies revealed significant group differences over occipito-temporal scalp regions. Distributed source analysis identified significantly higher activation in the right auditory cortex for CI users compared to NH controls, confirming visual take-over. Lip reading skills were significantly enhanced in the CI group and appeared to be particularly better after a longer duration of deafness, while face recognition was not significantly different between groups. However, auditory cortex activation in CI users was positively related to face recognition abilities. Our results confirm a cross-modal reorganization for ecologically valid visual stimuli in CI users. Furthermore, they suggest that residual takeover, which can persist even after adaptation to a CI is not necessarily maladaptive.

Auditory distraction transmitted by a cochlear implant alters allocation of attentional resources.

Cochlear implants (CIs) are auditory prostheses which restore hearing via electrical stimulation of the auditory nerve. The successful adaptation of auditory cognition to the CI input depends to a substantial degree on individual factors. We pursued an electrophysiological approach toward an analysis of cortical responses that reflect perceptual processing stages and higher-level responses to CI input. Performance and event-related potentials on two cross-modal discrimination-following-distraction (DFD) tasks from CI users and normal-hearing (NH) individuals were compared. The visual-auditory distraction task combined visual distraction with following auditory discrimination performance. Here, we observed similar cortical responses to visual distractors (Novelty-N2) and slowed, less accurate auditory discrimination performance in CI users when compared to NH individuals. Conversely, the auditory-visual distraction task was used to combine auditory distraction with visual discrimination performance. In this task we found attenuated cortical responses to auditory distractors (Novelty-P3), slowed visual discrimination performance, and attenuated cortical P3-responses to visual targets in CI users compared to NH individuals. These results suggest that CI users process auditory distractors differently than NH individuals and that the presence of auditory CI input has an adverse effect on the processing of visual targets and the visual discrimination ability in implanted individuals. We propose that this attenuation of the visual modality occurs through the allocation of neural resources to the CI input.