Relación entre hiperacusia y desorden del procesamiento auditivo central: Una revisión de la literatura / Relationship between hyperacusis and auditory processing disorder: a literature review

Resumen La hiperacusia corresponde a la excesiva sensibilidad auditiva o intolerancia a ciertos sonidos cotidianos que para la mayoría de las personas parecerían habituales. Considerando los mecanismos fisiológicos involucrados en el origen de la hiperacusia, es lógico pensar que su presencia podría afectar algunas habilidades del procesamiento auditivo central, sin embargo, la evidencia en torno al tema es escasa y no existe actualmente una revisión de la literatura que agrupe las investigaciones sobre esta temática. Por ello, el presente estudio pretende identificar y analizar la evidencia científica disponible sobre la relación entre hiperacusia y desorden del procesamiento auditivo central. Se realizó una revisión de la literatura guiada por protocolo PRISMA en las bases de datos Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library y Scielo de acuerdo con términos claves. Fueron incluidos artículos originales de investigación, revisiones sistemáticas y metaanálisis, publicados desde el año 2010, realizados en animales y humanos, escritos en idiomas inglés, español y portugués. Se encontraron 323 estudios relacionados con los términos claves utilizados, de los cuales 13 cumplieron con los criterios de inclusión y fueron analizados. Se puede concluir que la evidencia científica en torno al tema es escasa e incipiente. Estructuras de la vía auditiva central como núcleos cocleares, lemnisco lateral, colículos inferiores, cuerpo geniculado medial y corteza auditiva primaria estarían relacionadas con la hiperacusia, así como también habilidades de procesamiento auditivo de figura/fondo, ordenación temporal y transferencia interhemisférica se verían afectadas.

Abstract Hyperacusis has been defined as the excessive auditory sensitivity or intolerance to certain everyday sounds that seem common for most people. Considering the underlying physiological mechanisms of hyperacusis, it is reasonable to think that it could affect some abilities involved in the central auditory processing. However, there is lack of evidence about this topic, and there is no literature review that gathers all the existing research. Therefore, the current study intends to identify and analyze the available scientific evidence regarding the relationship between hyperacusis and central auditory processing disorder. The review of the literature followed the PRISMA protocol, using key words in Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library and Scielo databases. Original research articles, systematic reviews and meta-analyses of studies made with human and animals that have been published since 2010 in English, Spanish and Portuguese were included. Among them, 323 studies were related to the key terms, out of which 13 met the inclusion criteria and were analyzed. It is possible to conclude that there is little and incipient scientific evidence on the topic. Structures of the central auditory pathway such as cochlear nuclei, lateral lemniscus, inferior colliculi, medial geniculate body and primary auditory cortex seem to be related to hyperacusis; auditory processing skills such as figure/ground discrimination, temporal ordering and interhemispheric transfer appear to be affected as well.

Comparison of Relative Loudness Judgment in Children using Listening Devices with Typically Developing Children

Abstract Introduction Loudness perception is considered important for the perception of emotions, relative distance and stress patterns. However, certain digital hearing devices worn by those with hearing impairment may affect their loudness perception. This could happen in devices that have compression circuits to make loud sounds soft and soft sounds loud. These devices could hamper children from gaining knowledge about loudness of acoustical signals. Objective To compare relative loudness judgment of children using listening devices with age-matched typically developing children. Methods The relative loudness judgment of sounds created by day-to-day objects were evaluated on 60 children (20 normal-hearing, 20 hearing aid users, & 20 cochlear implant users), utilizing a standard group comparison design. Using a two-alternate forced-choice technique, the children were required to select picturized sound sources that were louder. Results The majority of the participants obtained good scores and poorer scores were mainly obtained by children using cochlear implants. The cochlear implant users obtained significantly lower scores than the normal-hearing participants. However, the scores were not significantly different between the normal-hearing children and the hearing aid users as well as between the two groups with hearing impairment. Conclusion Thus, despite loudness being altered by listening devices, children using non-linear hearing aids or cochlear implants are able to develop relative loudness judgment for acoustic stimuli. However, loudness growth for electrical stimuli needs to be studied.

Utilidad de mediciones objetivas para la programación en implantes cocleares / Use of objective measures for cochlear implant programming

RESUMEN Introducción: La programación adecuada de los implantes cocleares permiten lograr niveles de estimulación auditivos óptimos. Se realiza de forma individualizada, siendo la detección del umbral de confort ideal un desafío. Se ha descrito la utilidad de los potenciales auditivos del tronco encefálico eléctrico (ePEATC) y el reflejo eléctrico estapedial (eREE) para este propósito. Objetivo: Determinar la posibilidad de realizar ePEATC y eREE en pacientes adultos y pediátricos con implantes cocleares, y evaluar cambios en la programación de los implantes cocleares luego de las mediciones objetivas. Material y método: Se realizó un estudio prospectivo, descriptivo, de pacientes con implante coclear marca MED-EL®, separando los pacientes en dos grupos: el grupo adulto (n =5) y el grupo pediátrico (n =5). Todos los pacientes incluidos presentaron más de 6 meses de encendido del implante. Se evaluaron variables epidemiológicas y tiempo de encendido del implante. Se realizó una otoscopía, prueba básica de funcionamiento del implante, y las mediciones objetivas eléctricas (ePEATC, eREE). Con estos resultados se ajustó el umbral de confort. Resultados: El tiempo promedio de encendido del implante en el grupo adulto fue de 27 meses, y 30 meses en el grupo pediátrico. El ePEATC requiere más tiempo y cooperación al compararlo con eREE. Luego de estas evaluaciones objetivas, fue necesario el ajuste del umbral de confort en tres pacientes adultos, y en dos pacientes pediátricos. Fue necesario realizar una audiometría de campo libre para estimar el umbral de confort en dos pacientes pediátricos que no presentaron respuesta en eREE. Conclusión: Fue posible realizar estas mediciones objetivas en pacientes adultos y pediátricos, siendo mejor tolerado y requiriendo menos tiempo, el eREE.

ABSTRACT Introduction: Mapping a cochlear implant allows for adjusting ideal electrical stimulation limits. It is an individualized process and detecting the most comfortable loudness level can be challenging. The use of electrically evoked auditory brainstem response (ePEATC) and electrically evoked stapedius reflex thresholds (eREE) have been considered for this purpose. Aim: To determine the feasibility of performing ePEATC and eREE on adult and pediatric patients with a cochlear implant, and to evaluate changes in programming following these objective measures. Material and method: A prospective, descriptive study was completed, of patients with MED-EL® cochlear implants, separating patients into two groups: adults (n=5) and children (n=5). All of the patients included had their implants activated for 6 months or longer. Epidemiological variables and duration of implant activation were evaluated. Otoscopy, a basic implant functioning evaluation, and objective measures (ePEATC, eREE) were performed. With these results, comfortable loudness levels were adjusted. Results: Average duration of implant activation was 27 months and 30 months, for adults and children respectively. Performing ePEATC required more time and cooperation as compared to eREE. Following the objective measures, adjustment of the comfortable loudness levels was required for three adult and two pediatric patients. Sound field audiometry was necessary for two pediatric patients in order to estimate the comfortable loudness levels because the eREE responses were absent. Conclusions: It is feasible to perform these objective measures for both adult and pediatric patients, with eREE requiring less time and being better tolerated by patients.

Event-Related Potentials in Major Depressive Disorder / 신경정신의학

Many event-related potentials (ERPs) studies have been performed in major depressive disorder. ERPs include P50, N170, loudness dependence of auditory evoked potentials (LDAEP), P300, and mismatch negativity (MMN). These ERPs have good time-resolution as noninvasive methods, so they can be used easily in clinical practice and research. For example, ERPs can be used to differentiate patients from healthy people, as well as for assessing the subtype and severity, investigating the psychopathology, and predicting the treatment response in mental disorders. This review focuses on P50, N170, LDAEP, P300, and MMN in major depressive disorders.

Influência da retroalimentação auditiva nos parâmetros acústicos vocais de indivíduos sem queixas vocais / Influence of auditory feedback in the vocal acoustic parameters of individuals without vocal complaints

RESUMO Introdução: A qualidade da emissão vocal é dependente da integridade do mecanismo de retroalimentação auditiva. A presença de eventuais falhas nesse mecanismo está relacionada à indução do abuso e/ ou mau uso vocal e, por conseguinte, do surgimento de quadros de disfonia. Objetivo: Avaliar a influência da retroalimentação auditiva na intensidade e na frequência da voz, em indivíduos sem queixas vocais. Métodos: Participaram da pesquisa 40 sujeitos do gênero feminino, sem queixas vocais e com limiares auditivos dentro dos padrões de normalidade. As participantes foram submetidas a uma avaliação auditiva, composta por audiometria tonal liminar, imitanciometria e por uma avaliação acústica vocal dos parâmetros de intensidade e frequência, realizada em três momentos: antes, durante e após a exposição ao ruído branco. Resultados: Houve diferença significativa na relação das médias obtidas na intensidade e entre o limiar dos reflexos acústicos contralaterais e as frequências vocais, nos três momentos da avaliação acústica. Conclusão: Os achados sugerem que a retroalimentação auditiva interfere no controle da intensidade e frequência vocal.

ABSTRACT Introduction: The quality of the vocal emission is dependent on the integrity of the auditory feedback mechanism of the presence of eventual failures is related to the induction of abuse and / or vocal misuse, and therefore of the surgeon of dysphonia. Purpose: To evaluate the influence of auditory feedback in voice intensity and frequency in individuals with no vocal complaints. Methods: Participants were 40 female subjects without vocal and auditory thresholds within normal standards complaints. Participants underwent an auditory evaluation composed of pure tone audiometry, tympanometry and a vocal acoustic assessment of intensity and frequency parameters, carried out in three stages: before, during and after exposure to white noise. Results: There was significant difference in the average of the ratio obtained in intensity and between the threshold of contralateral acoustic reflexes and vocal frequencies in the three moments of acoustic evaluation. Conclusion: Thus, the findings suggest that auditory feedback interferes with the control of the intensity and vocal frequency.

Estimation of spectral oscillatory power of resting-state EEG in subjective tinnitus / 中国耳鼻咽喉头颈外科

OBJECTIVE To explor e the characteristics of spectral oscillatory power of resting-state electroencephalography(EEG) in subjective tinnitus patients and to lay the foundation for study of central mechanism of tinnitus.METHODS 31 subjects(15 subjects with subjective tinnitus and 16 age matching healthy subjects) underwent a 128-channel resting-state EEG analyses. After a series of preprocessing, data were segmented into 8 frequency bands, including δ(0.5～3.5 Hz), θ(4～7.5 Hz), α1(8～10 Hz), α2(10～12 Hz), β1(13～18 Hz), β2(18.5～21 Hz), β3(21.5～30 Hz) and γ(30.5～44 Hz). The group differences of spectral power were analyzed by independent t test. Correlation between spectral power of each frequency band and tinnitus subjective symptoms were also analyzed. RESULTS Significant higher spectral power of the α1, β and γ bandwere found in the left and right temporal areas of tinnitus group compared with that of normal group.Tinnitus subjects also had higher spectral powerof the δ and θ band in temporo-parietal areas than that of the normal group. There was no significant difference of spectral power in other frequency bands. Moreover, signif icant positive cor relation were found between tinnitus loudness and spectralpower of right anterior lateral(R=0.66, P =0.007) and right anterior medial(R=0.58, P =0.031) areas. CONCLUSION Tinnitus subjects have higher spectral oscillatory power on right and left temporal lobe and temporo-parietal area. A positive correlation exsit between tinnitus loudness andspectral power of right anterior lateral and medial areas in tinnitus subjects, whichindicate that central reorganizationexsit in tinnitus reorganization andγ band maybe considered as a possible biomarkerforthe tinnitus subjective symptom.

Development of Tabla Literature.

Percussion instruments have a special significance in the history of Indian instruments and instrumental music. Indian percussion instruments, in terms of their diversity, their qualitative characteristics and the variety sounds they produce, are not only astounding, but appreciable too. Tablā literature, in its own glory, has evolved from the vast sea of the multitude of sounds born out of the instrument. However, tablā literature, as contrasted to conventional literature, has its own tradition. The present discussion is an attempt to present this unique tradition.

Effects of Mandarin Speech Rate on Mandarin AcceptabIe Noise LeveI Test in NormaI Hearing AduIts / 听力学及言语疾病杂志

Objective To investigate the effects of Mandarin speech rate on Mandarin acceptable noise level test in normal hearing adults.Methods Using the national Putonghua proficiency test material to produce 0.8 times,1.0 times and 1.2 times speed rate of ANL test materials.ANL tests were measured for 58 normal hearing a-dults using different peed matetrials.For each case,the most comfortable loudness(MCL)and background noise lev-el(BNL)were found.The ANL was then computed by subtracting the mean BNL from MCL.ResuIts Statistic anal-ysis indicated that there were no significant differences of the ANL(P>0.05)among the differenct speed materials, there were no correlation between MCL-ANL (P>0.05),negatively correlation between BNL-ANL(P<0.05)a-mong the differenct speed materials.ConcIusion Mandarin speech speed does not effect ANL test,the more the in-dividual’s ability to accept the background noise,the smaller the value of ANL.

Clinical Implication of Loudness Dependence of Auditory Evoked Potential (LDAEP) in Psychiatic Illness

The loudness dependence of the auditory evoked potential (LDAEP) has been proposed as a valid biomarker of central serotoninergic activity in humans. The specificity and sensitivity of the LDAEP to changes in serotonergic neurotransmission have recently been explored in many studies about pharmacology and genetics. The majority of evidence for an association between the LDAEP and serotonin activity has come from animal studies. Genetic association studies with the LDAEP have provided conflicting reports with additional evidence outlining sensitivity to other neurotransmitter systems including the dopamine and glutamatergic systems. The LDAEP has been revealed to reflect the pathophysiology of various psychiatric illnesses. There is supporting evidence that major psychiatric disorders have differential LDAEP activities. Overall, the LDAEP shows strong evidence as a potential predictor of antidepressant treatment response. It need to be explored whether the LDAEP could be a biological marker of various psychiatric diseases and treatment prediction of antidepressants and serotonin related drugs.

Análise das modificações vocais de repórteres na situação de ruído / Analysis of reporters' vocal changes in the presence of noise

OBJETIVO: Verificar e comparar a ocorrência das modificações vocais de repórteres e não-repórteres na presença de ruído mascarante. MÉTODOS:Participaram 46 sujeitos, sendo 23 repórteres e 23 não-repórteres (grupo controle), todos com audição normal. Os participantes deveriam ler um trecho de uma matéria de telejornal em três situações de escuta: sem ruído mascarante, com ruído de 50 dB, e com ruído de 90 dB. As narrações foram gravadas e submetidas à avaliação perceptivo-auditiva (realizada por uma fonoaudióloga especialista em voz) e análise acústica (medidas extraídas por meio do Software Voxmetria - CTS Informática). RESULTADOS: Com 50 dB de mascaramento, houve maior aumento nos parâmetros pitch (82,6%), loudness (91,3%) e tensão (82,6%) no grupo controle, quando este foi comparado ao grupo dos repórteres. O mesmo ocorreu com ruído de 90 dB para os parâmetros pitch (95,7%), loudness (100%) e tensão (91,3%). CONCLUSÃO: As consequências negativas do efeito Lombard ocorrem em ambos os grupos, porém, pelas respostas apresentadas, os repórteres demonstram conseguir inibir parcialmente o impacto negativo das situações de ruído, por provável estabilidade da emissão profissional e ativação de outras vias de monitoramento.

PURPOSE: To investigate and compare the occurrence of vocal changes in the presence of masking noise between reporters and other professionals. METHODS: Participants were 46 subjects with normal hearing, 23 reporters (study group) and 23 non-reporters (control group). Participants read an excerpt from a TV news broadcast in three listening situations: without masking noise, with 50 dB white noise, and with 90 dB white noise. The narrations were recorded and then submitted to auditory-perceptual and acoustic analyses. The auditory-perceptual analysis was performed by a speech-language pathologist specialized in voice. The acoustic analysis used the software Voxmetria (CTS Informática) to perform the acoustic measurements. RESULTS: In the situation with 50 dB masking noise, individuals in the control group had higher increase of the following parameters, when compared to the group of reporters: pitch (82.6%), loudness (91.3%), and strain (82.6%). The same occurred in the situation with 90 dB masking noise for the same parameters: pitch (95.7%), loudness (100%) and strain (91.3%). CONCLUSION: The negative consequences of the Lombard effect occur in both groups; however, reporters showed the ability to partially inhibit the negative impact of noise situations, probably due to the stability of the professional speech production and activation of other feedback pathways.

Smoking Behavior and Loudness Dependence of the Auditory Evoked Potential among Male Patients with Major Depressive Disorder / 대한정신약물학회지

OBJECTIVE: The loudness dependence of the auditory evoked potential (LDAEP) has been known as an indicator of central serotonergic neurotransmission. Nicotine increases the release of serotonin levels. The current study investigated whether cigarette smoking would make difference in LDAEP among male patients with major depressive disorder. METHODS: Twenty-four non-smoking and 20 smoking male patients meeting DSM-IV criteria for major depressive disorder (MDD) were recruited. There was no significant difference in severity of MDD symptoms between the two groups. The age of participants ranged from 20 to 65 years old. Event-related potentials (ERP) N100 were measured on 5 different sounds (55, 65, 75, 85, 95 dB) and on 5 electrodes (Fz, Cz, Pz, C5, C6). The N1/P2 peak to peak amplitudes and amplitude slope according to 5 different sounds were calculated. RESULTS: LDAEP was significantly weaker in the smoking group in comparison to the non-smoking group (p<0.05). Among non-smoking group LDAEP was negatively correlated with a core depression subscale of Hamilton Rating Scale for Depression (HAM-D) (r=-0.41, p<0.05). CONCLUSION: LDAEP of the smoking patients with MDD group was weaker than the non-smoking patient with MDD group's. This result suggests that smoking may have increased the release of serotonergic neurotransmission in patients with MDD. Future studies need to examine LDAEP changes before and after tobacco use among smoking patients.

Desempenho de adultos jovens normais em dois testes de resolução temporal / Performance of normal young adults in two temporal resolution tests

TEMA: o processamento auditivo temporal se refere a percepção de um evento sonoro ou de uma alteração no mesmo, dentro de um intervalo definido de tempo e é considerado uma habilidade fundamental na percepção auditiva de sons verbais e não verbais, na percepção de música, ritmo e pontuação e na discriminação de pitch, de duração e de fonemas. OBJETIVO: realizar um estudo comparativo do desempenho de adultos jovens normais nos testes de resolução temporal, Random Gap Detection Test (RGDT) e Gaps-in-Noise (GIN) e analisar diferenças entre esses dois métodos de avaliação. MÉTODO: 25 universitários, 11 homens e 14 mulheres, com audição normal e sem histórico de alterações educacionais, neurológicas e/ou linguagem, foram submetidos ao RGDT e ao GIN, a 40dB NS. RESULTADO: observou-se diferença estatisticamente significante entre os sexos sendo que as mulheres apresentaram pior desempenho nos dois testes. No estudo comparativo dos resultados do RGDT e GIN, observaram-se diferenças significativas no desempenho da amostra. De maneira geral, os limiares de detecção de gap no teste GIN foram melhores do que os limiares obtidos no RGDT. CONCLUSÃO: o sexo masculino teve melhor desempenho tanto no teste RGDT quanto no GIN, quando comparado ao feminino. Além disso, não houve diferença significante nas repostas do GIN nas orelhas direita e esquerda. Os sujeitos deste estudo tiveram melhor desempenho no teste GIN, quando comparado ao RGDT, tanto no sexo masculino quanto no feminino. Portanto, o teste GIN apresentou vantagens sobre o RGDT não apenas quanto à sua validade e sensibilidade, mas também com relação a sua aplicação e correção dos resultados.

BACKGROUND: temporal auditory processing is defined as the perception of sound or of sound alteration within a restricted time interval and is considered a fundamental ability for the auditory perception of verbal and non verbal sounds, for the perception of music, rhythm, periodicity and in the discrimination of pitch, duration and of phonemes. AIM: to compare the performance of normal Brazilian adults in two temporal resolution tests: the Gaps-in-Noise Test (GIN) and the Random Gap Detection Test (RGDT), and to analyze potential differences of performance in these two tests. METHOD: twenty-five college students with normal hearing (11 males and 14 females) and no history of educational, neurological and/or language problems, underwent the GIN and RGDT at 40dB SL. RESULTS: statistically significant gender effects for both tests were found, with female participants showing poorer performance on both temporal processing tests. In addition, a comparative analysis of the results obtained in the GIN and RGDT revealed significant differences in the threshold measures derived for these two tests. In general, significantly better gap detection thresholds were observed for both male and female participants on the GIN test when compared to the results obtained for the RGDT. CONCLUSION: male participants presented better performances on both RGDT and GIN, when compared to the females. There were no differences in performance between right and left ears on the GIN test. Participants of the present investigation, males and females, performed better on the GIN when compared to the RGDT. The GIN presented advantages over the RGDT, not only in terms of clinical validity and sensibility, but also in terms of application and scoring.

The Analysis of Loudness Discomfort Level and Hyperacusis in Tinnitus Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyperacusis is an abnormally strong reaction which occurs within auditory pathways resulting from exposure to moderate sound. More patients are inflicted with it than with tinnitus, accounting for a relatively high proportion of the total tinnitus patients. However, no single test could pass as an objective diagnostic test of hyperacusis. Among various psychoacoustic evaluations, loudness discomfort level (LDL) is frequently used in the evaluation of hyperacusis. Thus, this study aimed to demonstrate a proportion of hyperacusis in tinnitus patients and characterize LDL in hyperacusis and tinnitus patients as a diagnostic test. MATERIALS AND METHOD: Using 186 patients with tinnitus as experiment group and 35 acoustically normal persons as control group, pure tone audiometry (PTA), LDL, and dynamic range (DR) were checked. RESULTS: Amongst the total number of tinnitus patients, there were 10 hyperacusis patients (5.38%). Those hyperacusis patients had much lower LDL (73.50 dB) and DR (41.50 dB) than tinnitus patients without hyperacusis (LDL: 100.90 dB, DR: 67.20 dB) as well as the control group (LDL: 104.86 dB, DR: 93.98 dB). CONCLUSION: Hyperacusis patients consist 5.38% (10/186) and have much lower LDL than tinnitus patients without hyperacusis and the control group. There is a positive correlation between hyperacusis and LDL. Therefore, in a diagnosis of hyperacusis, it is essential to check LDL and take a careful look into the history from patients.

Loudness Balance Test with Ipsilateral and Contralateral Test Tone in Unilateral Tinnitus Patients / 대한이비인후과학회지

BACKGROUND: Quantification of the loudness of tinnitus is important for evaluating tinnitus treatments and for assessing the validity of compensational claims, as well as for the fact that it is fundamental to many other types of tinnitus research. A common method for measuring the level of tinnitus is loudness matching test, i.e., adjusting the dB level of an external tone to match the loudness of tinnitus. Hence the objective comparision can be made between the tinnitus and the test tone. Traditionally the test measures ipsilateral side of the tinnitus. However due to recruitment, the result yields a misleadingly low sensation level. OBJECTIVES: The purpose of this study was to evaluate the differences of results between ipsilateral and contralateral test tone in loudness balance test. MAERIALS AND METHODS: Applying the loudness matching method, tinnitus levels were measured ipsilaterally and contralaterally for 55 patients with unilateral tinnitus. The subjects were divided into two subgroups according to hearing levels. The one subgroup (n=16) had normal hearing ranges while the other subgroup (n=39) experienced difficulties in hearing. To correct the effects of recruitment when there was sensorineural hearing loss in the ear to which the test sound was applied, the effective loudness level representation was adopted. Estimates of effective loudness levels were obtained using a normogram. RESULTS: The result is as follows: in the hearing-difficulty group, tinnitus levels measured ipsilaterally were correlated with those from the contralateral side. The correlation coefficient was 0.647. In the normal hearing group, tinnitus levels measured ipsilaterally did not correlate with those from the contralateral side. The correlation coefficient was 0.037. CONCLUSIONS: The results revealed that there is a difference between ipsilateral and contralateral methods in the loudness balance test of unilateral tinnitus due to compound effects of the recruitment, the hearing loss of tinnitus ear, and the neural interaction of central nervous system. It is therefore suggested that ipsilateral test tone is more accurate than contralateral tone for the evaluation of loudness balance.