Detecting Cochlear Synaptopathy Through Curvature Quantification of the Auditory Brainstem Response.

The sound-evoked electrical compound potential known as auditory brainstem response (ABR) represents the firing of a heterogenous population of auditory neurons in response to sound stimuli, and is often used for clinical diagnosis based on wave amplitude and latency. However, recent ABR applications to detect human cochlear synaptopathy have led to inconsistent results, mainly due to the high variability of ABR wave-1 amplitude. Here, rather than focusing on the amplitude of ABR wave 1, we evaluated the use of ABR wave curvature to detect cochlear synaptic loss. We first compared four curvature quantification methods using simulated ABR waves, and identified that the cubic spline method using five data points produced the most accurate quantification. We next evaluated this quantification method with ABR data from an established mouse model with cochlear synaptopathy. The data clearly demonstrated that curvature measurement is more sensitive and consistent in identifying cochlear synaptic loss in mice compared to the amplitude and latency measurements. We further tested this curvature method in a different mouse model presenting with otitis media. The change in curvature profile due to middle ear infection in otitis media is different from the profile of mice with cochlear synaptopathy. Thus, our study suggests that curvature quantification can be used to address the current ABR variability issue, and may lead to additional applications in the clinic diagnosis of hearing disorders.

Noise-induced cochlear synaptopathy: Past findings and future studies.

For decades, we have presumed the death of hair cells and spiral ganglion neurons are the main cause of hearing loss and difficulties understanding speech in noise, but new findings suggest synapse loss may be the key contributor. Specifically, recent preclinical studies suggest that the synapses between inner hair cells and spiral ganglion neurons with low spontaneous rates and high thresholds are the most vulnerable subcellular structures, with respect to insults during aging and noise exposure. This cochlear synaptopathy can be "hidden" because this synaptic loss can occur without permanent hearing threshold shifts. This new discovery of synaptic loss opens doors to new research directions. Here, we review a number of recent studies and make suggestions in two critical future research directions. First, based on solid evidence of cochlear synaptopathy in animal models, it is time to apply molecular approaches to identify the underlying molecular mechanisms; improved understanding is necessary for developing rational, effective therapies against this cochlear synaptopathy. Second, in human studies, the data supporting cochlear synaptopathy are indirect although rapid progress has been made. To fully identify changes in function that are directly related this hidden synaptic damage, we argue that a battery of tests including both electrophysiological and behavior tests should be combined for diagnosis of "hidden hearing loss" in clinical studies. This new approach may provide a direct link between cochlear synaptopathy and perceptual difficulties.

Perceptual context effects of speech and nonspeech sounds: the role of auditory categories.

Williams [(1986). "Role of dynamic information in the perception of coarticulated vowels," Ph.D. thesis, University of Connecticut, Standford, CT] demonstrated that nonspeech contexts had no influence on pitch judgments of nonspeech targets, whereas context effects were obtained when instructed to perceive the sounds as speech. On the other hand, Holt et al. [(2000). "Neighboring spectral content influences vowel identification," J. Acoust. Soc. Am. 108, 710-722] showed that nonspeech contexts were sufficient to elicit context effects in speech targets. The current study was to test a hypothesis that could explain the varying effectiveness of nonspeech contexts: Context effects are obtained only when there are well-established perceptual categories for the target stimuli. Experiment 1 examined context effects in speech and nonspeech signals using four series of stimuli: steady-state vowels that perceptually spanned from /inverted ohm/-/I/ in isolation and in the context of /w/ (with no steady-state portion) and two nonspeech sine-wave series that mimicked the acoustics of the speech series. In agreement with previous work context effects were obtained for speech contexts and targets but not for nonspeech analogs. Experiment 2 tested predictions of the hypothesis by testing for nonspeech context effects after the listeners had been trained to categorize the sounds. Following training, context-dependent categorization was obtained for nonspeech stimuli in the training group. These results are presented within a general perceptual-cognitive framework for speech perception research.

Effect of frequency boundary assignment on speech recognition with the Nucleus 24 ACE speech coding strategy.

The choice of frequency boundaries for the analysis channels of cochlear implants has been shown to impact the speech perception performance of adult recipients (Skinner et al, 1995; Fourakis et al, 2004). While technological limitations heretofore have limited the clinical feasibility of investigating novel frequency assignments, the SPEAR3 research processor affords the opportunity to investigate an unlimited number of possibilities. Here, four different assignments are evaluated using a variety of speech stimuli. All participants accommodated to assignment changes, and no one assignment was significantly preferred. The results suggest that better performance can be achieved using a strategy whereby (1) there are at least 7-8 electrodes allocated below 1000 Hz, (2) the majority of remaining electrodes are allocated between 1100-3000 Hz, and (3) the region above 3 kHz is represented by relatively few electrodes (i.e., 1-3). The results suggest that such frequency assignment flexibility should be made clinically available.

Evaluation of equivalency in two recordings of monosyllabic words.

Thirty "new" lists of monosyllabic words were created at the University of Melbourne and recorded by Australian and American English speakers. These new lists and the ten original CNC lists (Peterson and Lehiste, 1962) were used during the feasibility study of the Nucleus Research Platform 8 Cochlear Implant System (Holden et al, 2004). Performance was similar across original and new lists for six implanted Australian subjects; for four implanted U.S. subjects, mean performance was 23 percentage points lower with the new than with the original lists. To evaluate differences between original and new lists for the American English recording, 22 CI recipients were administered all 40 CNC lists (30 new and 10 original lists). The overall mean word score for the new lists was significantly lower (22.3 percentage points) than for the original lists. Acoustic analysis revealed that decreased performance was most likely due to reduced amplitudes of certain initial and final consonants. The new CNC lists can be used as more difficult test material for clinical research.

Bi-syllabic, modern Greek word lists for use in word recognition tests.

The development of a word recognition test for Modern Greek, which is comprised of three fifty-word lists, is described herein. The development was guided by four principles: (1) use of the shortest words possible (two syllables for Greek) (2) use of highly frequent words (3) phonetic balance and (4) appropriate balance of first and second syllable stress. The lists were recorded by one male and one female native speakers. Thirty-seven native speakers of Greek listened to all words by both speakers. Across lists, the mean correct identification score was 97.9% for the female voice (95% confidence interval 96.97 to 98.84) and 96.5% (95% confidence interval 95.31 to 97.77) for the male voice. This small difference was statistically significant (p < .01) and concentrated on words with first syllable stress. In future work, these recordings can be used in adult tests of speech perception and can be modified for tests of central auditory processing.

Effect of frequency boundary assignment on vowel recognition with the Nucleus 24 ACE speech coding strategy.

Two speech processor programs (MAPs) differing only in electrode frequency boundary assignments were created for each of eight Nucleus 24 Cochlear Implant recipients. The default MAPs used typical frequency boundaries, and the experimental MAPs reassigned one additional electrode to vowel formant regions. Four objective speech tests and a questionnaire were used to evaluate speech recognition with the two MAPs. Results for the closed-set vowel test and the formant discrimination test showed small but significant improvement in scores with the experimental MAP. Differences for the Consonant-Vowel Nucleus-Consonant word test and closed-set consonant test were nonsignificant. Feature analysis revealed no significant differences in information transmission. Seven of the eight subjects preferred the experimental MAP, reporting louder, crisper, and clearer sound. The results suggest that Nucleus 24 recipients should be given an opportunity to compare a MAP that assigns more electrodes in vowel formant regions with the default MAP to determine which provides the most benefit in everyday life.