Auditory dysfunction in traumatic brain injury.

Effective communication is essential for successful rehabilitation, especially in patients with traumatic brain injury (TBI). The authors examined the prevalence and characteristics of auditory dysfunction in patients with TBI who were admitted to a Department of Veterans Affairs TBI inpatient unit before and after the onset of Operation Iraqi Freedom (OIF). In order to delineate the characteristics of the auditory manifestations of patients who had sustained blast-related (BR) TBI, we reviewed the medical records of 252 patients with TBI and categorized them according to admission date, either before (Group I, n = 102) or after (Group II, n = 150) the onset of OIF. We subdivided Group II into non-blast-related (NBR) and BR TBI; no subjects in Group I had BR TBI. We found that admissions for TBI have increased 47% since the onset of OIF. In Group I, 28% of patients with TBI complained of hearing loss and 11% reported tinnitus. In Group II-NBR (n = 108), 44% complained of hearing loss and 18% reported tinnitus. In Group II-BR (n = 42), 62% complained of hearing loss and 38% reported tinnitus. Sensorineural loss was the most prevalent type of hearing loss in Group II-BR patients. In light of the high prevalence of hearing loss and tinnitus in this growing population of returning soldiers, we need to develop and implement strategies for diagnosis and management of these conditions.

Dyslipidemia and auditory function.

The relationship between dyslipidemia and hearing is unclear. This study was conducted to investigate whether elevated serum lipid levels impact auditory function in humans and in guinea pigs. In the human study, a cross-sectional study of 40 volunteers with dyslipidemia was conducted. Pure tone thresholds, distortion product otoacoustic emissions, and lipid profiles were analyzed. When controlled for patient age and sex, we found that elevated triglycerides were associated with reduced hearing. In the guinea pig study, a prospective study of animals fed a high-fat diet for 14 weeks was conducted. Although the high-fat diet led to a dramatic elevation in the average weight and total cholesterol in all animals (from 61 to 589 mg/dl), there were no meaningful changes in distortion product otoacoustic emission magnitudes. These results suggest that whereas chronic dyslipidemia associated with elevated triglycerides may reduce auditory function, short-term dietary changes may not.

Complementing behavioral measures with electrophysiological measures in diagnostic evaluation: a case study in two languages.

This case study focuses on a bilingual, older man who spoke Polish and English and showed weaknesses on clinical measures of dichotic listening in English. It was unclear whether these test results were influenced by the participant's facility with his second language or by other nonauditory factors. To elucidate the nature of this deficit, the authors examined behavioral and electrophysiological responses during dichotic-listening tasks involving linguistic processing in both languages. A diotic (control) condition was included to examine whether nonauditory factors, such as language familiarity, memory, or decline in speed of mental processing, might explain the dichotic results. The results from this participant were compared with those obtained from a bilingual young adult who also spoke both Polish and English. Results showed a substantial left-ear deficit for the older individual on both behavioral and electrophysiological measures of dichotic listening. The pattern of results is consistent with previous findings in demonstrating that the left-ear deficit in this patient derived from an auditory-specific defect rather than from any of the extra-auditory factors associated with language facility or cognitive decline.

Some effects of aging on central auditory processing.

Seniors often have more difficulty understanding speech than younger adults, particularly in noisy environments. While loss in peripheral hearing sensitivity explains many of the listening problems of elderly persons, age-related declines in general cognitive skill and central auditory processing also appear to contribute. In this article, we focus primarily on the effects of age on central auditory mechanisms. To this end, we review research examining a central locus for deficits in temporal processing and summarize behavioral and event-related potential findings from our laboratory's research on the effects of aging on dichotic listening performance. Results show that age-related deficits in interhemispheric information processing may underlie some of the listening problems among seniors. We also discuss implications for clinical audiological rehabilitative efforts in this population.

Processing of affective prosody and lexical-semantics in spoken utterances as differentiated by event-related potentials.

In the current study, event-related potentials (ERPs) were utilized to assess whether ERP correlates would distinguish between prosodic and lexical-semantic information processed during the comprehension of a spoken affective message. To this end, we employed a standard oddball paradigm with stimuli varying in lexical-semantic or prosodic characteristics. An N400 component was obtained in response to all stimuli and conditions (non-targets and targets). Greater negativity in the N400 amplitude was observed in response to semantic as compared to prosodic stimuli. An anterior (P3a) positive component was increased for prosodic as compared to semantic targets. We also investigated whether an N400 and/or P3a component would be present when a stimulus carried affective semantic and affective prosodic information. The ERP structure observed in response to targets of this condition showed a reduction in the amplitude of the N400 component and an explicit anterior P3a component, significantly greater than the P3a component in response to prosodic or semantic targets. Finally, a P3b component was evoked in response to targets, regardless of communicative dimension.

Brainstem auditory-evoked potentials as an objective tool for evaluating hearing dysfunction in traumatic brain injury.

Because of the violent nature of traumatic brain injury, traumatic brain injury patients are susceptible to various types of trauma involving the auditory system. We report a case of a 55-yr-old man who presented with communication problems after traumatic brain injury. Initial results from behavioral audiometry and Weber/Rinne tests were not reliable because of poor cooperation. He was transferred to our service for inpatient rehabilitation, where review of the initial head computed tomographic scan showed only left temporal bone fracture. Brainstem auditory-evoked potential was then performed to evaluate his hearing function. The results showed bilateral absence of auditory-evoked responses, which strongly suggested bilateral deafness. This finding led to a follow-up computed tomographic scan, with focus on bilateral temporal bones. A subtle transverse fracture of the right temporal bone was then detected, in addition to the left temporal bone fracture previously identified. Like children with hearing impairment, traumatic brain injury patients may not be able to verbalize their auditory deficits in a timely manner. If hearing loss is suspected in a patient who is unable to participate in traditional behavioral audiometric testing, brainstem auditory-evoked potential may be an option for evaluating hearing dysfunction.