Envelope following responses for hearing diagnosis: Robustness and methodological considerations.

Recent studies have found that envelope following responses (EFRs) are a marker of age-related and noise- or ototoxic-induced cochlear synaptopathy (CS) in research animals. Whereas the cochlear injury can be well controlled in animal research studies, humans may have an unknown mixture of sensorineural hearing loss [SNHL; e.g., inner- or outer-hair-cell (OHC) damage or CS] that cannot be teased apart in a standard hearing evaluation. Hence, a direct translation of EFR markers of CS to a differential CS diagnosis in humans might be compromised by the influence of SNHL subtypes and differences in recording modalities between research animals and humans. To quantify the robustness of EFR markers for use in human studies, this study investigates the impact of methodological considerations related to electrode montage, stimulus characteristics, and presentation, as well as analysis method on human-recorded EFR markers. The main focus is on rectangularly modulated pure-tone stimuli to evoke the EFR based on a recent auditory modelling study that showed that the EFR was least affected by OHC damage and most sensitive to CS in this stimulus configuration. The outcomes of this study can help guide future clinical implementations of electroencephalography-based SNHL diagnostic tests.

Predicting synapse counts in living humans by combining computational models with auditory physiology.

Aging, noise exposure, and ototoxic medications lead to cochlear synapse loss in animal models. As cochlear function is highly conserved across mammalian species, synaptopathy likely occurs in humans as well. Synaptopathy is predicted to result in perceptual deficits including tinnitus, hyperacusis, and difficulty understanding speech-in-noise. The lack of a method for diagnosing synaptopathy in living humans hinders studies designed to determine if noise-induced synaptopathy occurs in humans, identify the perceptual consequences of synaptopathy, or test potential drug treatments. Several physiological measures are sensitive to synaptopathy in animal models including auditory brainstem response (ABR) wave I amplitude. However, it is unclear how to translate these measures to synaptopathy diagnosis in humans. This work demonstrates how a human computational model of the auditory periphery, which can predict ABR waveforms and distortion product otoacoustic emissions (DPOAEs), can be used to predict synaptic loss in individual human participants based on their measured DPOAE levels and ABR wave I amplitudes. Lower predicted synapse numbers were associated with advancing age, higher noise exposure history, increased likelihood of tinnitus, and poorer speech-in-noise perception. These findings demonstrate the utility of this modeling approach in predicting synapse counts from physiological data in individual human subjects.

Envelope following responses predict speech-in-noise performance in normal-hearing listeners.

Permanent threshold elevation after noise exposure or aging is caused by loss of sensory cells; however, animal studies show that hair cell loss is often preceded by degeneration of the synapses between sensory cells and auditory nerve fibers. Silencing these neurons is likely to degrade auditory processing and may contribute to difficulties understanding speech in noisy backgrounds. Reduction of suprathreshold ABR amplitudes can be used to quantify synaptopathy in inbred mice. However, ABR amplitudes are highly variable in humans, and thus more challenging to use. Since noise-induced neuropathy preferentially targets fibers with high thresholds and low spontaneous rate and because phase locking to temporal envelopes is particularly strong in these fibers, measuring envelope following responses (EFRs) might be a more robust measure of cochlear synaptopathy. A recent auditory model further suggests that modulation of carrier tones with rectangular envelopes should be less sensitive to cochlear amplifier dysfunction and, therefore, a better metric of cochlear neural damage than sinusoidal amplitude modulation. In this study, we measure performance scores on a variety of difficult word-recognition tasks among listeners with normal audiograms and assess correlations with EFR magnitudes to rectangular versus sinusoidal modulation. Higher harmonics of EFR magnitudes evoked by a rectangular-envelope stimulus were significantly correlated with word scores, whereas those evoked by sinusoidally modulated tones did not. These results support previous reports that individual differences in synaptopathy may be a source of speech recognition variability despite the presence of normal thresholds at standard audiometric frequencies.NEW & NOTEWORTHY Recent studies suggest that millions of people may be at risk of permanent impairment from cochlear synaptopathy, the age-related and noise-induced degeneration of neural connections in the inner ear. This study examines electrophysiological responses to stimuli designed to improve detection of neural damage in subjects with normal hearing sensitivity. The resultant correlations with word recognition performance are consistent with a contribution of cochlear neural damage to deficits in hearing in noise abilities.

Auditory Brainstem Response Latency in Noise as a Marker of Cochlear Synaptopathy.

Evidence from animal and human studies suggests that moderate acoustic exposure, causing only transient threshold elevation, can nonetheless cause "hidden hearing loss" that interferes with coding of suprathreshold sound. Such noise exposure destroys synaptic connections between cochlear hair cells and auditory nerve fibers; however, there is no clinical test of this synaptopathy in humans. In animals, synaptopathy reduces the amplitude of auditory brainstem response (ABR) wave-I. Unfortunately, ABR wave-I is difficult to measure in humans, limiting its clinical use. Here, using analogous measurements in humans and mice, we show that the effect of masking noise on the latency of the more robust ABR wave-V mirrors changes in ABR wave-I amplitude. Furthermore, in our human cohort, the effect of noise on wave-V latency predicts perceptual temporal sensitivity. Our results suggest that measures of the effects of noise on ABR wave-V latency can be used to diagnose cochlear synaptopathy in humans. SIGNIFICANCE STATEMENT: Although there are suspicions that cochlear synaptopathy affects humans with normal hearing thresholds, no one has yet reported a clinical measure that is a reliable marker of such loss. By combining human and animal data, we demonstrate that the latency of auditory brainstem response wave-V in noise reflects auditory nerve loss. This is the first study of human listeners with normal hearing thresholds that links individual differences observed in behavior and auditory brainstem response timing to cochlear synaptopathy. These results can guide development of a clinical test to reveal this previously unknown form of noise-induced hearing loss in humans.

Model-based estimation of the frequency tuning of the inner-hair-cell stereocilia from neural tuning curves.

This study proposes that the frequency tuning of the inner-hair-cell (IHC) stereocilia in the intact organ of Corti can be derived from the responses of the auditory fibers (AFs) using computational tools. The frequency-dependent relationship between the AF threshold and the amplitude of the stereocilia vibration is estimated using a model of the IHC-mediated mechanical to neural transduction. Depending on the response properties of the considered AF, the amplitude of stereocilia deflection required to drive the simulated AF above threshold is 1.4 to 9.2 dB smaller at low frequencies (≤500 Hz) than at high frequencies (≥4 kHz). The estimated frequency-dependent relationship between ciliary deflection and neural threshold is employed to derive constant-stereocilia-deflection contours from previously published AF recordings from the chinchilla cochlea. This analysis shows that the transduction process partially accounts for the observed differences between the tuning of the basilar membrane and that of the AFs.

Individual differences reveal correlates of hidden hearing deficits.

Clinical audiometry has long focused on determining the detection thresholds for pure tones, which depend on intact cochlear mechanics and hair cell function. Yet many listeners with normal hearing thresholds complain of communication difficulties, and the causes for such problems are not well understood. Here, we explore whether normal-hearing listeners exhibit such suprathreshold deficits, affecting the fidelity with which subcortical areas encode the temporal structure of clearly audible sound. Using an array of measures, we evaluated a cohort of young adults with thresholds in the normal range to assess both cochlear mechanical function and temporal coding of suprathreshold sounds. Listeners differed widely in both electrophysiological and behavioral measures of temporal coding fidelity. These measures correlated significantly with each other. Conversely, these differences were unrelated to the modest variation in otoacoustic emissions, cochlear tuning, or the residual differences in hearing threshold present in our cohort. Electroencephalography revealed that listeners with poor subcortical encoding had poor cortical sensitivity to changes in interaural time differences, which are critical for localizing sound sources and analyzing complex scenes. These listeners also performed poorly when asked to direct selective attention to one of two competing speech streams, a task that mimics the challenges of many everyday listening environments. Together with previous animal and computational models, our results suggest that hidden hearing deficits, likely originating at the level of the cochlear nerve, are part of "normal hearing."

On the Interplay Between Cochlear Gain Loss and Temporal Envelope Coding Deficits.

Hearing impairment is characterized by two potentially coexisting sensorineural components: (i) cochlear gain loss that yields wider auditory filters, elevated hearing thresholds and compression loss, and (ii) cochlear neuropathy, a noise-induced component of hearing loss that may impact temporal coding fidelity of supra-threshold sound. This study uses a psychoacoustic amplitude modulation (AM) detection task in quiet and multiple noise backgrounds to test whether these aspects of hearing loss can be isolated in listeners with normal to mildly impaired hearing ability. Psychoacoustic results were compared to distortion-product otoacoustic emission (DPOAE) thresholds and envelope-following response (EFR) measures. AM thresholds to pure-tone carriers (4 kHz) in normal-hearing listeners depended on temporal coding fidelity. AM thresholds in hearing-impaired listeners were normal, indicating that reduced cochlear gain may counteract how reduced temporal coding fidelity degrades AM thresholds. The amount with which a 1-octave wide masking noise worsened AM detection was inversely correlated to DPOAE thresholds. The narrowband noise masker was shown to impact the hearing-impaired listeners more so than the normal hearing listeners, suggesting that this masker may be targeting a temporal coding deficit. This study offers a window into how psychoacoustic difference measures can be adopted in the differential diagnostics of hearing deficits in listeners with mixed forms of sensorineural hearing loss.

A comparative study of seven human cochlear filter models.

Auditory models have been developed for decades to simulate characteristics of the human auditory system, but it is often unknown how well auditory models compare to each other or perform in tasks they were not primarily designed for. This study systematically analyzes predictions of seven publicly-available cochlear filter models in response to a fixed set of stimuli to assess their capabilities of reproducing key aspects of human cochlear mechanics. The following features were assessed at frequencies of 0.5, 1, 2, 4, and 8 kHz: cochlear excitation patterns, nonlinear response growth, frequency selectivity, group delays, signal-in-noise processing, and amplitude modulation representation. For each task, the simulations were compared to available physiological data recorded in guinea pigs and gerbils as well as to human psychoacoustics data. The presented results provide application-oriented users with comprehensive information on the advantages, limitations and computation costs of these seven mainstream cochlear filter models.

Functional modeling of the human auditory brainstem response to broadband stimulation.

Population responses such as the auditory brainstem response (ABR) are commonly used for hearing screening, but the relationship between single-unit physiology and scalp-recorded population responses are not well understood. Computational models that integrate physiologically realistic models of single-unit auditory-nerve (AN), cochlear nucleus (CN) and inferior colliculus (IC) cells with models of broadband peripheral excitation can be used to simulate ABRs and thereby link detailed knowledge of animal physiology to human applications. Existing functional ABR models fail to capture the empirically observed 1.2-2 ms ABR wave-V latency-vs-intensity decrease that is thought to arise from level-dependent changes in cochlear excitation and firing synchrony across different tonotopic sections. This paper proposes an approach where level-dependent cochlear excitation patterns, which reflect human cochlear filter tuning parameters, drive AN fibers to yield realistic level-dependent properties of the ABR wave-V. The number of free model parameters is minimal, producing a model in which various sources of hearing-impairment can easily be simulated on an individualized and frequency-dependent basis. The model fits latency-vs-intensity functions observed in human ABRs and otoacoustic emissions while maintaining rate-level and threshold characteristics of single-unit AN fibers. The simulations help to reveal which tonotopic regions dominate ABR waveform peaks at different stimulus intensities.

Transmission line cochlear models: improved accuracy and efficiency.

This paper presents an efficient method to compute the numerical solutions of transmission-line (TL) cochlear models, and its application on the model of Verhulst et al. The stability region of the model is extended by adopting a variable step numerical method to solve the system of ordinary differential equations that describes it, and by adopting an adaptive scheme to take in account variations in the system status within each numerical step. The presented method leads to improve simulations numerical accuracy and large computational savings, leading to employ TL models for more extensive simulations than currently possible.

Effects of spontaneous otoacoustic emissions on pure-tone frequency difference limens.

Pure-tone frequency difference limens (FDLs) have been shown to vary in the vicinity of spontaneous otoacoustic emissions (SOAEs). As lower FDLs have been observed near SOAEs when measured ipsi- and contralaterally to the emission ear, it has been proposed that prolonged ongoing stimulation of nerve cells tuned to the SOAE frequency could lead to a central oversensitivity to that frequency, hence a better frequency-discrimination ability. However, it is also known that tones close in frequency to an SOAE can "entrain" the emission to oscillate at their own frequency. This may instead explain the variations in FDL near SOAE frequencies as arising from peripheral interactions between SOAEs and external tones in the cochlea. To test these two hypotheses, SOAE entrainment patterns and FDLs were recorded in seven subjects with an ipsilateral SOAE and no neighboring contralateral SOAE. Ipsilateral FDLs were lowest in the SOAE entrainment region and worsened significantly when beating between the external tone and SOAE occurred. FDLs remained unaffected in the non-emission ear and did not alter with continuous ipsilateral or contralateral presentation of a pure tone aimed at emulating an SOAE. These findings suggest a mechanical rather than neural origin for the variations in FDL near SOAE frequencies.

The role of hidden hearing loss in tinnitus: Insights from early markers of peripheral hearing damage.

Since the presence of tinnitus is not always associated with audiometric hearing loss, it has been hypothesized that hidden hearing loss may act as a potential trigger for increased central gain along the neural pathway leading to tinnitus perception. In recent years, the study of hidden hearing loss has improved with the discovery of cochlear synaptopathy and several objective diagnostic markers. This study investigated three potential markers of peripheral hidden hearing loss in subjects with tinnitus: extended high-frequency audiometric thresholds, the auditory brainstem response, and the envelope following response. In addition, speech intelligibility was measured as a functional outcome measurement of hidden hearing loss. To account for age-related hidden hearing loss, participants were grouped according to age, presence of tinnitus, and audiometric thresholds. Group comparisons were conducted to differentiate between age- and tinnitus-related effects of hidden hearing loss. All three markers revealed age-related differences, whereas no differences were observed between the tinnitus and non-tinnitus groups. However, the older tinnitus group showed improved performance on low-pass filtered speech in noise tests compared to the older non-tinnitus group. These low-pass speech in noise scores were significantly correlated with tinnitus distress, as indicated using questionnaires, and could be related to the presence of hyperacusis. Based on our observations, cochlear synaptopathy does not appear to be the underlying cause of tinnitus. The improvement in low-pass speech-in-noise could be explained by enhanced temporal fine structure encoding or hyperacusis. Therefore, we recommend that future tinnitus research takes into account age-related factors, explores low-frequency encoding, and thoroughly assesses hyperacusis.

Neural Adaptation at Stimulus Onset and Speed of Neural Processing as Critical Contributors to Speech Comprehension Independent of Hearing Threshold or Age.

Background: It is assumed that speech comprehension deficits in background noise are caused by age-related or acquired hearing loss. Methods: We examined young, middle-aged, and older individuals with and without hearing threshold loss using pure-tone (PT) audiometry, short-pulsed distortion-product otoacoustic emissions (pDPOAEs), auditory brainstem responses (ABRs), auditory steady-state responses (ASSRs), speech comprehension (OLSA), and syllable discrimination in quiet and noise. Results: A noticeable decline of hearing sensitivity in extended high-frequency regions and its influence on low-frequency-induced ABRs was striking. When testing for differences in OLSA thresholds normalized for PT thresholds (PTTs), marked differences in speech comprehension ability exist not only in noise, but also in quiet, and they exist throughout the whole age range investigated. Listeners with poor speech comprehension in quiet exhibited a relatively lower pDPOAE and, thus, cochlear amplifier performance independent of PTT, smaller and delayed ABRs, and lower performance in vowel-phoneme discrimination below phase-locking limits (/o/-/u/). When OLSA was tested in noise, listeners with poor speech comprehension independent of PTT had larger pDPOAEs and, thus, cochlear amplifier performance, larger ASSR amplitudes, and higher uncomfortable loudness levels, all linked with lower performance of vowel-phoneme discrimination above the phase-locking limit (/i/-/y/). Conslusions: This study indicates that listening in noise in humans has a sizable disadvantage in envelope coding when basilar-membrane compression is compromised. Clearly, and in contrast to previous assumptions, both good and poor speech comprehension can exist independently of differences in PTTs and age, a phenomenon that urgently requires improved techniques to diagnose sound processing at stimulus onset in the clinical routine.

Cochlear contributions to the precedence effect.

Normal-hearing individuals have sharply tuned auditory filters, and consequently their basilar-membrane (BM) impulse responses (IRs) have durations of several ms at frequencies in the range from 0 to 5 kHz. When presenting clicks that are several ms apart, the BM IRs to the individual clicks will overlap in time, giving rise to complex interactions that have not been fully understood in the human cochlea. The perceptual consequences of these BM IR interactions are of interest as lead-lag click pairs are often used to study localization and the precedence effect. The present study aimed at characterizing perceptual consequences of BM IR interactions in individual listeners based on click-evoked otoacoustic emissions (CEOAEs) and auditory brainstem responses (ABRs). Lag suppression, denoting the level difference between the CEOAE or wave-V response amplitude evoked by the first and the second clicks, was observed for inter-click intervals (ICIs) between 1 and 4 ms. Behavioral correlates of lag suppression were obtained for the same individuals by investigating the percept of the lead-lag click pairs presented either monaurally or binaurally. The click pairs were shown to give rise to fusion (i.e., the inability to hear out the second click in a lead-lag click pair), regardless of monaural or binaural presentation. In both cases, the ICI range where the percept was a fused image correlated well with the ICI range for which monaural lag suppression occurred in the CEOAE and ABR (i.e., for ICIs below 4.3 ms). Furthermore, the lag suppression observed in the wave-V amplitudes to binaural stimulation did not show additional contributions to the lag suppression obtained monaurally, suggesting that peripheral lag suppression up to the level of the brainstem is dominant in the perception of the precedence effect.

Evaluation of Lifetime Noise Exposure History Reporting.

PURPOSE: The purpose of this study is to critically evaluate lifetime noise exposure history (LNEH) reporting. First, two different approaches to evaluate the cumulative LNEH were compared. Second, individual LNEH was associated with the subjects' hearing status. Third, loudness estimates of exposure activities, by means of Jokitulppo- and Ferguson-based exposure levels, were compared with dosimeter sound-level measurements. METHOD: One hundred one young adults completed the questionnaires, and a subgroup of 30 subjects underwent audiological assessment. Pure-tone audiometry, speech-in-noise intelligibility, distortion product otoacoustic emissions, auditory brainstem responses, and envelope following responses were included. Fifteen out of the 30 subjects took part in a noisy activity while wearing a dosimeter. RESULTS: First, results demonstrate that the structured questionnaire yielded a greater amount of information pertaining to the diverse activities, surpassing the insights obtained from an open-ended questionnaire. Second, no significant correlations between audiological assessment and LNEH were found. Lastly, the results indicate that Ferguson-based exposure levels offer a more precise estimation of the actual exposure levels, in contrast to Jokitulppo-based estimates. CONCLUSIONS: We propose several recommendations for determining the LNEH. First, it is vital to define accurate loudness categories and corresponding allocated levels, with a preference for the loudness levels proposed by Ferguson et al. (2019), as identified in this study. Second, a structured questionnaire regarding LNEH is recommended, discouraging open-ended questioning. Third, it is essential to include a separate category exclusively addressing work-related activities, encompassing various activities for more accurate surveying.

Wireless and Wearable Auditory EEG Acquisition Hardware Using Around-The-Ear cEEGrid Electrodes.

Aside from a clinical interest in electroencephalography (EEG) measurements of real-time data with a high temporal resolution, there is a demand for acquisition systems that are operable outside the laboratory environment. In this study, we designed a wearable and low-power EEG system for multichannel EEG acquisition beyond the lab doors. Around-the-ear cEEGrid electrodes are used to capture 8 biopotential channels which are amplified by low-power precision instrumentation amplifiers and passed on to an analog-to-digital converter (ADC). An ESP32 micro-controller captures the data from the ADC and stores it on an external SD card. The proposed system is compared to a state-of-the-art EEG acquisition system (BioSemi) to assess its diagnostic power for auditory brainstem responses (ABRs). The recordings with our portable system match, and even outperform, the baseline method's specifications. Our hardware opens up new avenues for fast sampling-rate auditory EEG recordings that can be used in hearing diagnostics, damage prevention and treatment follow up.

Nonlinear time-domain cochlear model for transient stimulation and human otoacoustic emission.

This paper describes the implementation and performance of a nonlinear time-domain model of the cochlea for transient stimulation and human otoacoustic emission generation. The nonlinearity simulates compressive growth of measured basilar-membrane impulse responses. The model accounts for reflection and distortion-source otoacoustic emissions (OAEs) and simulates spontaneous OAEs through manipulation of the middle-ear reflectance. The model was calibrated using human psychoacoustical and otoacoustic tuning parameters. It can be used to investigate time-dependent properties of cochlear mechanics and the generator mechanisms of otoacoustic emissions. Furthermore, the model provides a suitable preprocessor for human auditory perception models where realistic cochlear excitation patterns are desired.

Model-based hearing-enhancement strategies for cochlear synaptopathy pathologies.

It is well known that ageing and noise exposure are important causes of sensorineural hearing loss, and can result in damage of the outer hair cells or other structures of the inner ear, including synaptic damage to the auditory nerve (AN), i.e., cochlear synaptopathy (CS). Despite the suspected high prevalence of CS among people with self-reported hearing difficulties but seemingly normal hearing, conventional hearing-aid algorithms do not compensate for the functional deficits associated with CS. Here, we present and evaluate a number of auditory signal-processing strategies designed to maximally restore AN coding for listeners with CS pathologies. We evaluated our algorithms in subjects with and without suspected age-related CS to assess whether physiological and behavioural markers associated with CS can be improved. Our data show that after applying our algorithms, envelope-following responses and perceptual amplitude-modulation sensitivity were consistently enhanced in both young and older listeners. Speech-in-noise intelligibility showed small improvements after processing but mostly for young normal-hearing participants, with median improvements of up to 8.3%. Since our hearing-enhancement strategies were designed to optimally drive the AN fibres, they were able to improve temporal-envelope processing for listeners both with and without suspected CS. Our proposed algorithms can be rapidly executed and can thus extend the application range of current hearing aids and hearables, while leaving sound amplification unaffected.

A comparative study of eight human auditory models of monaural processing.

A number of auditory models have been developed using diverging approaches, either physiological or perceptual, but they share comparable stages of signal processing, as they are inspired by the same constitutive parts of the auditory system. We compare eight monaural models that are openly accessible in the Auditory Modelling Toolbox. We discuss the considerations required to make the model outputs comparable to each other, as well as the results for the following model processing stages or their equivalents: Outer and middle ear, cochlear filter bank, inner hair cell, auditory nerve synapse, cochlear nucleus, and inferior colliculus. The discussion includes a list of recommendations for future applications of auditory models.

Temporal suppression of the click-evoked otoacoustic emission level-curve.

The click-evoked otoacoustic emission (CEOAE) level-curve grows linearly for clicks below 40-60 dB and saturates for higher inputs. This study investigates dynamic (i.e., time-dependent) features of the CEOAE level-curve by presenting a suppressor-click less than 8 ms before the test-click. An alteration of the CEOAE level-curve, designated here as temporal suppression, was observed within this time period, and was shown to depend on the levels and the temporal separation of the two clicks. Temporal suppression occurred for all four subjects tested, and resulted in a vertical offset from the unsuppressed level-curve for test-click levels greater than 50 dB peak-equivalent level (peSPL). Temporal suppression was greatest for suppressors presented 1-4 ms before the test click, and the magnitude and time scale of the effect were subject dependent. Temporal suppression was furthermore observed for the short- (i.e., 6-18 ms) and long-latency (i.e., 24-36 ms) regions of the CEOAE, indicating that temporal suppression similarly affects synchronized spontaneous otoacoustic emissions (SSOAEs) and purely evoked CEOAE components. Overall, this study demonstrates that temporal suppression of the CEOAE level-curve reflects a dynamic process in human cochlear processing that works on a time scale of 0-10 ms.