Serum Prestin Level May Increase Following Music Exposure That Induces Temporary Threshold Shifts: A Pilot Study.

OBJECTIVES: To determine if blood prestin level changes after exposure to music at high sound pressure levels, and if this change is associated with temporary threshold shift (TTS) and/or changes in distortion product (DP) amplitude. DESIGN: Participants were exposed to pop-rock music at 100 dBA for 15 min monaurally through headphones. Pure-tone audiometry, DP amplitude, and blood prestin level were measured before and after exposure. RESULTS: Fourteen adults (9 women; age range: 20 to 54 years, median age = 31 [Interquartile ratio = 6.75]) with normal hearing were included in the study. Mean prestin level increased shortly after exposure to music, then returned to baseline within 1 week, although this trend was not observed in all participants. All participants presented TTS or a decrease in DP amplitude in at least one frequency after music exposure. There was a statistically significant average threshold elevation at 4 min postexposure. Statistically significant DP amplitude shifts were observed at 4 and 6 kHz, 2 min following exposure. Mean baseline serum prestin level (mean: 140.00 pg/mL, 95% confidence interval (CI): 125.92 to 154.07) progressively increased following music exposure, reaching a maximum at 2 hr (mean: 158.29 pg/mL, 95% CI: 130.42 to 186.66) and returned to preexposure level at 1 week (mean: 139.18 pg/mL, 95% CI: 114.69 to 163.68). However, after correction for multiple comparisons, mean prestin level showed no statistically significant increase from baseline at any timepoint. No correlation between maximum blood prestin level change and average TTS or distortion product otoacoustic emission amplitude shift was found. However, in an exploratory analysis, TTS at 6 kHz (the frequency at which maximum TTS occurred) decreased significantly as baseline blood prestin level increased. CONCLUSIONS: The results suggest that blood prestin level may change after exposure to music at high sound pressure levels, although statistical significance was not reached in this relatively small sample after correction. Baseline serum prestin level may also predict the degree of TTS. These findings thus suggest that the role of baseline serum prestin level as a proxy marker of cochlear susceptibility to intense music exposure should be further explored.

The diversity of speech-perception difficulties among autistic individuals.

Background & aims: Communicative and sensory differences are core autistic traits, yet speech-perception abilities and difficulties among autistic individuals remain poorly understood. Laboratory studies have produced mixed and inconclusive results, in part because of the lack of input from autistic individuals in defining the hypotheses and shaping the methods used in this field of research. Little in-depth qualitative research on autistic experiences of speech perception has been published, yet such research could form the basis for better laboratory research, for improved understanding of autistic experiences, and for the development of interventions. Existing qualitative research describes widespread autistic listening differences with significant impacts, but these results rely on data gathered via oral interviews in a small sample. The present study addresses these limitations and employs a mixed-methods approach to explore autistic listening experiences. Methods: We gathered survey data from 79 autistic individuals aged 18-55 without diagnosed hearing loss. The questionnaire included 20 closed-set questions on listening abilities and difficulties and three free-text questions on listening experiences. The free-text questions underwent deductive content analysis using a framework composed of themes from previous interview data on listening experiences (including auditory differences, contributing factors, impacts, and coping strategies). Concepts in the free-text data that were not part of the analysis framework were analyzed inductively. Results: In the closed-set data, participants reported listening difficulties in most specified environments, but complex background sounds and particularly background voices caused the most difficulty. Those who reported listening difficulties expressed having substantially greater difficulties than other people the same age. Participants indicated multiple impacts from listening difficulties, most prominently in their social lives. Concepts in the free-text data strongly supported previous interview data on listening differences and factors that affect listening ability, especially the diversity of types of listening difficulties. Consistent with the closed-set data, background-sound complexity and concurrent voices were especially troubling. Some concepts in the free-text data were novel, particularly difficulties with remote, broadcast, and recorded audio, prompting the creation of new themes. Conclusions: Both forms of data indicate widespread listening differences-predominantly listening difficulties-affecting most autistic adults. Diverse types of listening difficulty are evident, potentially indicating heterogeneous underlying mechanisms, and complexity of background noise is consistently identified as an important factor. Listening difficulties are said to have substantial and varied impacts. Autistic adults are keen to share coping strategies, which are varied and usually self-devised. Implications: Based on both the quantitative and qualitative results, we provide recommendations to improve future research and support the autistic community. The data-revealing types of listening difficulties can guide better quantitative research into underlying mechanisms. Such research should take into account potential heterogeneity in listening difficulties. Suggestions for optimized collection of self-report data are also offered. Additionally, our results could be used to improve societal understanding of autistic listening differences and to create beneficial interventions for and with autistic individuals. Moreover, given the willingness of the autistic community to share coping strategies, systematic collation of these strategies could form the basis for self-help and clinical guidance.

Development and Validation of an Efficient and Safe Loud Music Exposure Paradigm.

PURPOSE: The purpose of this study was to develop a time-efficient music exposure and testing paradigm that safely creates temporary cochlear dysfunction that could be used in future temporary threshold shift (TTS) studies. METHOD: A 30-min audio compilation of pop rock music tracks was created. Adult volunteers with normal hearing were then exposed to this music material monaurally through headphones for 30 min at 97 dBA or 15 min at 100 dBA. Levels were measured from the ear of a manikin and are considered to provide an equivalent daily noise dose based on a 3-dB exchange. We assessed the changes in their hearing, by means of distortion product otoacoustic emission (DPOAE) testing, and standard and extended high-frequency pure-tone audiometry before and after exposure. There were 17 volunteers in total. In the first trial, eight volunteers (four females; Mdnage = 31 years [interquartile range, IQR = 4.25]) were included. Although TTS was observed in all eight participants for at least one frequency, a large variation in affected frequencies was observed. To address this issue, the audio material was further remastered to adjust levels across the different frequency bands. Fourteen adults (nine newly recruited and five from the first trial; seven females; Mdnage = 31 years [IQR = 5]) were exposed to the new material. RESULTS: All but two of 17 participants presented clinically significant TTS or decrease in DPOAE amplitude in at least one frequency. Statistically significant average TTS of 7.43 dB was observed at 6 kHz. There were statistically significant average DPOAE amplitude shifts of -2.55 dB at 4 kHz, -4.97 dB at 6 kHz, and -3.14 dB at 8 kHz. No participant presented permanent threshold shift. CONCLUSIONS: A monaural music paradigm was developed and shown to induce statistically significant TTS and DPOAE amplitude shifts, without evidence of permanent loss. This realistic and time-efficient paradigm may be considered a viable option for experimental studies of temporary music-induced hearing loss. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25016471.

The effect of motor resource suppression on speech perception in noise in younger and older listeners: An online study.

Speech motor resources may be recruited to assist challenging speech perception in younger normally hearing listeners, but the extent to which this occurs for older adult listeners is unclear. We investigated if speech motor resources are also recruited in older adults during speech perception. Specifically, we investigated if suppression of speech motor resources via sub-vocal rehearsal affects speech perception compared to non-speech motor suppression (jaw movement) and passive listening. Participants identified words in speech-shaped noise at signal-to-noise ratios (SNRs) from -16 to +16 dB in three listening conditions during which participants: (1) opened and closed their jaw (non-speech movement); (2) sub-vocally mimed 'the' (articulatory suppression); (3) produced no concurrent movement (passive listening). Data from 46 younger adults (M age = 20.17 years, SD = 1.61, 36 female) and 41 older adults (M age = 69 years, SD = 5.82, 21 female) were analysed. Linear mixed effects modelling investigated the impact of age, listening condition, and self-reported hearing ability on speech perception (d' prime). Results indicated that speech perception ability was significantly worse in older adults relative to younger adults across all listening conditions. A significant interaction between age group and listening condition indicated that younger adults showed poorer performance during articulatory suppression compared to passive listening, but older adults performed equivalently across conditions. This finding suggests that speech motor resources are less available to support speech perception in older adults, providing important insights for auditory-motor integration for speech understanding and communication in ageing.

Corrigendum: The effect of lifetime noise exposure and aging on speech-perception-in-noise ability and self-reported hearing symptoms: an online study.

[This corrects the article DOI: 10.3389/fnagi.2022.890010.].

Is Hearing Loss a Risk Factor for Idiopathic Parkinson's Disease? An English Longitudinal Study of Ageing Analysis.

Observations that hearing loss is a substantial risk factor for dementia may be accounted for by a common pathology. Mitochondrial oxidative stress and alterations in α-synuclein pathology may be common pathology candidates. Crucially, these candidate pathologies are implicated in Parkinson's disease (PD). Consequently, hearing loss may be a risk factor for PD. Subsequently, this prospective cohort study of the English Longitudinal Study of Ageing examines whether hearing loss is a risk factor for PD longitudinally. Participants reporting self-reported hearing capabilities and no PD diagnosis prior to entry (n = 14,340) were used. A joint longitudinal and survival model showed that during a median follow up of 10 years (SD = 4.67 years) increased PD risk (p < 0.001), but not self-reported hearing capability (p = 0.402). Additionally, an exploratory binary logistic regression modelling the influence of hearing loss identified using a screening test (n = 4812) on incident PD indicated that neither moderate (p = 0.794), nor moderately severe/severe hearing loss (p = 0.5210), increased PD risk, compared with normal hearing. Whilst discrepancies with prior literature may suggest a neurological link between hearing loss and PD, further large-scale analyses using clinically derived hearing loss are needed.

The Impact of Age and Psychosocial Factors on Cognitive and Auditory Outcomes During the COVID-19 Pandemic.

PURPOSE: In March 2020, the U.K. government announced that people should isolate to reduce the spread of the virus that causes COVID-19. Outside a pandemic, psychosocial factors, such as socialization and mental health, may impact the relationship between hearing loss and increased dementia risk. We aim to report the impact of psychosocial factors, including social isolation, depression, and engagement in activities, on hearing and cognitive function in younger and older adults during the COVID-19 pandemic. METHOD: An online survey and experiment assessed self-reported psychosocial factors, self-reported hearing ability and speech-in-noise perception, and cognition. Data were collected between June 2020 and February 2021. Older (n = 112, Mage = 70.08) and younger (n = 121, Mage = 20.52) monolingual speakers of English, without any language or neurological disorders participated. Multiple linear regression models were employed to investigate hypothesized associations between psychosocial factors, and hearing and cognition, in older and younger adults. RESULTS: Multiple regression analyses indicated that older adults displayed poorer speech-in-noise perception and poorer performance on one of four cognitive tasks, compared with younger adults; increased depression was associated with poorer subjective hearing. Other psychosocial factors did not significantly predict hearing or cognitive function. CONCLUSIONS: Data suggest that self-reported hearing and depression are related. This conclusion is important for understanding the associations between hearing loss and cognitive decline in the long term, as both hearing loss and depression are risk factors for dementia. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23810838.

Investigating the lateralisation of experimentally induced auditory verbal hallucinations.

Introduction: Auditory verbal hallucinations (AVHs), or hearing non-existent voices, are a common symptom in psychosis. Recent research suggests that AVHs are also experienced by neurotypical individuals. Individuals with schizophrenia experiencing AVHs and neurotypicals who are highly prone to hallucinate both produce false positive responses in auditory signal detection. These findings suggest that voice-hearing may lie on a continuum with similar mechanisms underlying AVHs in both populations. Methods: The current study used a monaural auditory stimulus in a signal detection task to test to what extent experimentally induced verbal hallucinations are (1) left-lateralised (i.e., more likely to occur when presented to the right ear compared to the left ear due to the left-hemisphere dominance for language processing), and (2) predicted by self-reported hallucination proneness and auditory imagery tendencies. In a conditioning task, fifty neurotypical participants associated a negative word on-screen with the same word being played via headphones through successive simultaneous audio-visual presentations. A signal detection task followed where participants were presented with a target word on-screen and indicated whether they heard the word being played concurrently amongst white noise. Results: Results showed that Pavlovian audio-visual conditioning reliably elicited a significant number of false positives (FPs). However, FP rates, perceptual sensitivities, and response biases did not differ between either ear. They were neither predicted by hallucination proneness nor auditory imagery. Discussion: The results show that experimentally induced FPs in neurotypicals are not left-lateralised, adding further weight to the argument that lateralisation may not be a defining feature of hallucinations in clinical or non-clinical populations. The findings also support the idea that AVHs may be a continuous phenomenon that varies in severity and frequency across the population. Studying induced AVHs in neurotypicals may help identify the underlying cognitive and neural mechanisms contributing to AVHs in individuals with psychotic disorders.

Noise Exposure in Palestinian Workers Without a Diagnosis of Hearing Impairment: Relations to Speech-Perception-in-Noise Difficulties, Tinnitus, and Hyperacusis.

PURPOSE: Many workers in developing countries are exposed to unsafe occupational noise due to inadequate health and safety practices. We tested the hypotheses that occupational noise exposure and aging affect speech-perception-in-noise (SPiN) thresholds, self-reported hearing ability, tinnitus presence, and hyperacusis severity among Palestinian workers. METHOD: Palestinian workers (N = 251, aged 18-70 years) without diagnosed hearing or memory impairments completed online instruments including a noise exposure questionnaire; forward and backward digit span tests; hyperacusis questionnaire; the short-form Speech, Spatial and Qualities of Hearing Scale (SSQ12); the Tinnitus Handicap Inventory; and a digits-in-noise (DIN) test. Hypotheses were tested via multiple linear and logistic regression models, including age and occupational noise exposure as predictors, and with sex, recreational noise exposure, cognitive ability, and academic attainment as covariates. Familywise error rate was controlled across all 16 comparisons using the Bonferroni-Holm method. Exploratory analyses evaluated effects on tinnitus handicap. A comprehensive study protocol was preregistered. RESULTS: Nonsignificant trends of poorer SPiN performance, poorer self-reported hearing ability, greater prevalence of tinnitus, greater tinnitus handicap, and greater severity of hyperacusis as a function of higher occupational noise exposure were observed. Greater hyperacusis severity was significantly predicted by higher occupational noise exposure. Aging was significantly associated with higher DIN thresholds and lower SSQ12 scores, but not with tinnitus presence, tinnitus handicap, or hyperacusis severity. CONCLUSIONS: Workers in Palestine may suffer from auditory effects of occupational noise and aging despite no formal diagnosis. These findings highlight the importance of occupational noise monitoring and hearing-related health and safety practices in developing countries. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22056701.

Binaural temporal coding and the middle ear muscle reflex in audiometrically normal young adults.

Noise exposure may damage the synapses that connect inner hair cells with auditory nerve fibers, before outer hair cells are lost. In humans, this cochlear synaptopathy (CS) is thought to decrease the fidelity of peripheral auditory temporal coding. In the current study, the primary hypothesis was that higher middle ear muscle reflex (MEMR) thresholds, as a proxy measure of CS, would be associated with smaller values of the binaural intelligibility level difference (BILD). The BILD, which is a measure of binaural temporal coding, is defined here as the difference in thresholds between the diotic and the antiphasic versions of the digits in noise (DIN) test. This DIN BILD may control for factors unrelated to binaural temporal coding such as linguistic, central auditory, and cognitive factors. Fifty-six audiometrically normal adults (34 females) aged 18 - 30 were tested. The test battery included standard pure tone audiometry, tympanometry, MEMR using a 2 kHz elicitor and 226 Hz and 1 kHz probes, the Noise Exposure Structured Interview, forward digit span test, extended high frequency (EHF) audiometry, and diotic and antiphasic DIN tests. The study protocol was pre-registered prior to data collection. MEMR thresholds did not predict the DIN BILD. Secondary analyses showed no association between MEMR thresholds and the individual diotic and antiphasic DIN thresholds. Greater lifetime noise exposure was non-significantly associated with higher MEMR thresholds, larger DIN BILD values, and lower (better) antiphasic DIN thresholds, but not with diotic DIN thresholds, nor with EHF thresholds. EHF thresholds were associated with neither MEMR thresholds nor any of the DIN outcomes, including the DIN BILD. Results provide no evidence that young, audiometrically normal people incur CS with impacts on binaural temporal processing.

Chasing the conversation: Autistic experiences of speech perception.

Background and aims: Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical sensory reactivity and social communication difficulties are pervasive, yet the research literature lacks in-depth self-report data on speech perception in this population. The present study aimed to elicit detailed first-person accounts of autistic individuals' abilities and difficulties perceiving the spoken word. Methods: Semi-structured interviews were conducted with nine autistic adults. The interview schedule addressed interviewees' experiences of speech perception, factors influencing those experiences, and responses to those experiences. Resulting interview transcripts underwent thematic analysis. The six-person study team included two autistic researchers, to reduce risk of neurotypical 'overshadowing' of autistic voices. Results: Most interviewees reported pronounced difficulties perceiving speech in the presence of competing sounds. They emphasised that such listening difficulties are distinct from social difficulties, though the two can add and interact. Difficulties were of several varieties, ranging from powerful auditory distraction to drowning out of voices by continuous sounds. Contributing factors encompassed not only features of the soundscape but also non-acoustic factors such as multisensory processing and social cognition. Participants also identified compounding factors, such as lack of understanding of listening difficulties. Impacts were diverse and sometimes disabling, affecting socialising, emotions, fatigue, career, and self-image. A wide array of coping mechanisms was described. Conclusions: The first in-depth qualitative investigation of autistic speech-perception experiences has revealed diverse and widespread listening difficulties. These can combine with other internal, interpersonal, and societal factors to induce profound impacts. Lack of understanding of such listening difficulties - by the self, by communication partners, by institutions, and especially by clinicians - appears to be a crucial exacerbating factor. Many autistic adults have developed coping strategies to lessen speech-perception difficulties or mitigate their effects, and these are generally self-taught due to lack of clinical support. Implications: There is a need for carefully designed, adequately powered confirmatory research to verify, quantify, and disentangle the various forms of listening difficulty, preferably using large samples to explore heterogeneity. More immediate benefit might be obtained through development of self-help and clinical guidance materials, and by raising awareness of autistic listening experiences and needs, among the autistic community, communication partners, institutions, and clinicians.

The impact of age-related hearing loss on structural neuroanatomy: A meta-analysis.

This meta-analysis investigated the association between age-related hearing loss and structural neuroanatomy, specifically changes to gray matter volume. Hearing loss is associated with increased risk of cognitive decline. Hence, understanding the effects of hearing loss in older age on brain health is essential. We reviewed studies which compared older participants with hearing loss (age-related hearing loss: ARHL) to older adults without clinical hearing loss (no-ARHL), on neuroanatomical outcomes, specifically gray matter (GM) volume as measured by magnetic resonance imaging. A total of five studies met the inclusion criteria, three of which were included in an analysis of whole-brain gray matter volume (ARHL group n = 113; no-ARHL group n = 138), and three were included in analyses of lobe-wise gray matter volume (ARHL group n = 139; no-ARHL group n = 162). Effect-size seed-based d mapping software was employed for whole-brain and lobe-wise analysis of gray matter volume. The analysis indicated there was no significant difference between adults with ARHL compared to those with no-ARHL in whole-brain gray matter volume. Due to lacking stereotactic coordinates, the level of gray matter in specific neuroanatomical locations could only be observed at lobe-level. These data indicate that adults with ARHL show increased gray matter atrophy in the temporal lobe only (not in occipital, parietal, or frontal), compared to adults with no-ARHL. The implications for theoretical frameworks of the hearing loss and cognitive decline relationship are discussed in relation to the results. This meta-analysis was pre-registered on PROSPERO (CRD42021265375). Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=265375, PROSPERO CRD42021265375.

The Relative and Combined Effects of Noise Exposure and Aging on Auditory Peripheral Neural Deafferentation: A Narrative Review.

Animal studies have shown that noise exposure and aging cause a reduction in the number of synapses between low and medium spontaneous rate auditory nerve fibers and inner hair cells before outer hair cell deterioration. This noise-induced and age-related cochlear synaptopathy (CS) is hypothesized to compromise speech recognition at moderate-to-high suprathreshold levels in humans. This paper evaluates the evidence on the relative and combined effects of noise exposure and aging on CS, in both animals and humans, using histopathological and proxy measures. In animal studies, noise exposure seems to result in a higher proportion of CS (up to 70% synapse loss) compared to aging (up to 48% synapse loss). Following noise exposure, older animals, depending on their species, seem to either exhibit significant or little further synapse loss compared to their younger counterparts. In humans, temporal bone studies suggest a possible age- and noise-related auditory nerve fiber loss. Based on the animal data obtained from different species, we predict that noise exposure may accelerate age-related CS to at least some extent in humans. In animals, noise-induced and age-related CS in separation have been consistently associated with a decreased amplitude of wave 1 of the auditory brainstem response, reduced middle ear muscle reflex strength, and degraded temporal processing as demonstrated by lower amplitudes of the envelope following response. In humans, the individual effects of noise exposure and aging do not seem to translate clearly into deficits in electrophysiological, middle ear muscle reflex, and behavioral measures of CS. Moreover, the evidence on the combined effects of noise exposure and aging on peripheral neural deafferentation in humans using electrophysiological and behavioral measures is even more sparse and inconclusive. Further research is necessary to establish the individual and combined effects of CS in humans using temporal bone, objective, and behavioral measures.

The Effect of Lifetime Noise Exposure and Aging on Speech-Perception-in-Noise Ability and Self-Reported Hearing Symptoms: An Online Study.

Animal research shows that aging and excessive noise exposure damage cochlear outer hair cells, inner hair cells, and the synapses connecting inner hair cells with the auditory nerve. This may translate into auditory symptoms such as difficulty understanding speech in noise, tinnitus, and hyperacusis. The current study, using a novel online approach, assessed and quantified the effects of lifetime noise exposure and aging on (i) speech-perception-in-noise (SPiN) thresholds, (ii) self-reported hearing ability, and (iii) the presence of tinnitus. Secondary aims involved documenting the effects of lifetime noise exposure and aging on tinnitus handicap and the severity of hyperacusis. Two hundred and ninety-four adults with no past diagnosis of hearing or memory impairments were recruited online. Participants were assigned into two groups: 217 "young" (age range: 18-35 years, females: 151) and 77 "older" (age range: 50-70 years, females: 50). Participants completed a set of online instruments including an otologic health and demographic questionnaire, a dementia screening tool, forward and backward digit span tests, a noise exposure questionnaire, the Khalfa hyperacusis questionnaire, the short-form of the Speech, Spatial, and Qualities of Hearing scale, the Tinnitus Handicap Inventory, a digits-in-noise test, and a Coordinate Response Measure speech-perception test. Analyses controlled for sex and cognitive function as reflected by the digit span. A detailed protocol was pre-registered, to guard against "p-hacking" of this extensive dataset. Lifetime noise exposure did not predict SPiN thresholds, self-reported hearing ability, or the presence of tinnitus in either age group. Exploratory analyses showed that worse hyperacusis scores, and a greater prevalence of tinnitus, were associated significantly with high lifetime noise exposure in the young, but not in the older group. Age was a significant predictor of SPiN thresholds and the presence of tinnitus, but not of self-reported hearing ability, tinnitus handicap, or severity of hyperacusis. Consistent with several lab studies, our online-derived data suggest that older adults with no diagnosis of hearing impairment have a poorer SPiN ability and a higher risk of tinnitus than their younger counterparts. Moreover, lifetime noise exposure may increase the risk of tinnitus and the severity of hyperacusis in young adults with no diagnosis of hearing impairment.

Extended high-frequency audiometry in research and clinical practice.

Audiometric testing in research and in clinical settings rarely considers frequencies above 8 kHz. However, the sensitivity of young healthy ears extends to 20 kHz, and there is increasing evidence that testing in the extended high-frequency (EHF) region, above 8 kHz, might provide valuable additional information. Basal (EHF) cochlear regions are especially sensitive to the effects of aging, disease, ototoxic drugs, and possibly noise exposure. Hence, EHF loss may be an early warning of damage, useful for diagnosis and for monitoring hearing health. In certain environments, speech perception may rely on EHF information, and there is evidence for an association between EHF loss and speech perception difficulties, although this may not be causal: EHF loss may instead be a marker for sub-clinical damage at lower frequencies. If there is a causal relation, then amplification in the EHF range may be beneficial if the technical difficulties can be overcome. EHF audiometry in the clinic presents with no particular difficulty, the biggest obstacle being lack of specialist equipment. Currently, EHF audiometry has limited but increasing clinical application. With the development of international guidelines and standards, it is likely that EHF testing will become widespread in future.

Threshold Equalizing Noise Test Reveals Suprathreshold Loss of Hearing Function, Even in the "Normal" Audiogram Range.

OBJECTIVES: The threshold equalizing noise (TEN(HL)) is a clinically administered test to detect cochlear "dead regions" (i.e., regions of loss of inner hair cell [IHC] connectivity), using a "pass/fail" criterion based on the degree of elevation of a masked threshold in a tone-detection task. With sensorineural hearing loss, some elevation of the masked threshold is commonly observed but usually insufficient to create a "fail" diagnosis. The experiment reported here investigated whether the gray area between pass and fail contained information that correlated with factors such as age or cumulative high-level noise exposure (>100 dBA sound pressure levels), possibly indicative of damage to cochlear structures other than the more commonly implicated outer hair cells. DESIGN: One hundred and twelve participants (71 female) who underwent audiometric screening for a sensorineural hearing loss, classified as either normal or mild, were recruited. Their age range was 32 to 74 years. They were administered the TEN test at four frequencies, 0.75, 1, 3, and 4 kHz, and at two sensation levels, 12 and 24 dB above their pure-tone absolute threshold at each frequency. The test frequencies were chosen to lie either distinctly away from, or within, the 2 to 6 kHz region where noise-induced hearing loss is first clinically observed as a notch in the audiogram. Cumulative noise exposure was assessed by the Noise Exposure Structured Interview (NESI). Elements of the NESI also permitted participant stratification by music experience. RESULTS: Across all frequencies and testing levels, a strong positive correlation was observed between elevation of TEN threshold and absolute threshold. These correlations were little-changed even after noise exposure and music experience were factored out. The correlations were observed even within the range of "normal" hearing (absolute thresholds ≤15 dB HL). CONCLUSIONS: Using a clinical test, sensorineural hearing deficits were observable even within the range of clinically "normal" hearing. Results from the TEN test residing between "pass" and "fail" are dominated by processes not related to IHCs. The TEN test for IHC-related function should therefore only be considered for its originally designed function, to generate a binary decision, either pass or fail.

Relations between speech-reception, psychophysical temporal processing, and subcortical electrophysiological measures of auditory function in humans.

There is a large amount of variability in performance in masked-speech reception tasks, as well as in psychophysical auditory temporal processing tasks, between listeners with normal or relatively normal low-frequency hearing. In this study we used a cross-sectional dataset collected on 102 listeners (34 young, 34 middle-aged, 34 older) to assess whether variance in these tasks could be explained by variance in subcortical electrophysiological measures of auditory function (auditory brainstem responses and frequency following responses), and whether variance in speech-reception performance could be explained by variance in auditory temporal processing tasks. The potential confounding effect of high-frequency sensitivity was strictly controlled for by using highpass masking noise. Because each high-level construct (masked-speech reception, auditory temporal processing, and subcortical electrophysiological function) was indexed by several variables, we used principal component analyses to reduce the dimensionality of the dataset. Multiple-regression models were then used to assess the associations between the extracted principal components while controlling for a range of possible confounders including age and audiometric thresholds. We found that masked-speech reception was credibly associated with psychophysical auditory temporal processing abilities. No credible associations were found between masked-speech reception and electrophysiological measures of subcortical auditory function, or between psychophysical measures of auditory temporal processing and electrophysiological measures of subcortical auditory function. These results suggest that either the electrophysiological measures of subcortical auditory function used were not sufficiently sensitive to the subcortical neural processes limiting performance in the speech-reception and psychophysical auditory temporal-processing tasks, or that variance in these tasks is largely unrelated to variance in subcortical neural processes in listeners with near-normal hearing.

Self-reported hearing difficulties are associated with loneliness, depression and cognitive dysfunction during the COVID-19 pandemic.

OBJECTIVE: To investigate whether hearing difficulties exacerbate the damaging effects of enforced social distancing due to the COVID-19 pandemic on isolation and loneliness, and lead to accelerated mental health issues and cognitive dysfunction. DESIGN: Rapid online survey. Participants completed a series of online questionnaires regarding hearing ability, socialisation (pre- and during-pandemic), loneliness, anxiety, depression and cognitive function. STUDY SAMPLE: A total of 80 participants over the age of 70 with access to the internet. RESULTS: There was a significant reduction in socialisation levels from pre-pandemic in this population. Hearing difficulties were significantly associated with greater levels of loneliness, depression and self-perceived cognitive dysfunction after controlling for age, gender, and level of education. Additionally, compared to pre-pandemic, people with hearing difficulties had increased odds of reporting worsened anxiety, depression, and memory during the COVID-19 pandemic, although only the effect of hearing difficulties on the change in memory reached statistical significance after controlling for age, gender, and level of education. CONCLUSIONS: The worse the self-reported hearing abilities are, the greater the negative impact of enforced social distancing on depression, loneliness and cognitive function.

Identifying barriers and facilitators of hearing protection use in early-career musicians: a basis for designing interventions to promote uptake and sustained use.

OBJECTIVE: The current study aimed to: i) determine the patterns of hearing protection device (HPD) use in early-career musicians, ii) identify barriers to and facilitators of HPD use, and iii) use the Behaviour Change Wheel (BCW) to develop an intervention to increase uptake and sustained use of HPDs. DESIGN: A mixed-methods approach using questionnaires and semi-structured interviews. STUDY SAMPLE: Eighty early-career musicians (age range = 18-26 years; women n = 39), across all categories of musical instrument. RESULTS: 42.5% percent of participants reported using HPDs at least once a week, 35% less than once a week, and 22.5% reported never using HPDs for music-related activities. Six barriers and four facilitators of HPD use were identified. Barriers include the impact of HPDs on listening to music and performing, and a lack of concern about noise exposure. Barriers/facilitators were mapped onto the Theoretical Domains Framework. Following the systematic process of the BCW, our proposed intervention strategies are based on 'Environmental Restructuring', such as providing prompts to increase awareness of noisy settings, and 'Persuasion/Modelling', such as providing credible role models. CONCLUSIONS: For the first time, the present study demonstrates the use of the BCW for designing interventions in the context of hearing conservation.

Is COVID-19 associated with self-reported audio-vestibular symptoms?

OBJECTIVE: To determine if a positive test for COVID-19 is associated with self-reported audio-vestibular symptoms. DESIGN: Self-reported changes in hearing, tinnitus, hyperacusis, and dizziness/rotatory vertigo were assessed in hospitalised and non-hospitalised COVID-19 patients during and after the acute phase of the disease and compared to non-COVID controls. STUDY SAMPLE: There were 150 severe cases of COVID-19 requiring hospital admission and 150 mild cases that were managed at home. Controls were 267 adults, 32 of whom had been hospitalised for a non-COVID-19 condition, and a further 85 who worked in hospital settings. RESULTS: Deterioration in hearing and/or tinnitus was reported in 8% of the COVID-19 cases (tinnitus had resolved in 2% after the acute phase), with no significant difference between severe and mild cases. Deterioration in hearing or tinnitus was not significantly different from controls. However, rotatory vertigo was reported by 5% in the COVID-19 groups and 1.1% in the controls, and this difference was statistically significant. CONCLUSIONS: There is no evidence that COVID-19 results in deterioration in hearing or tinnitus during the acute phase or after recovery in mild or severe cases. However, rotatory vertigo, which could be vestibular in origin, may be a clinical manifestation of COVID-19.