Audiology and Neurotology 2023-03-23

Direct Elicitation of Cortical Auditory Evoked Potentials by Electrical Stimulation and Their Use to Verify the Most Comfortable Level of Stimulation in Cochlear Implant Users

D Tavora-Vieira,E Ffoulkes

Publication date 23-03-2023

Introduction: This study was designed to investigate the use of electrically evoked cortical auditory evoked potentials (eCAEPs) as a tool for cochlear implant (CI) verification, the relationships between the site and intensity of stimulation and the detection rates and morphologies of eCAEPs as well as investigate whether correlations exist between the morphologies of eCAEPs and speech perception in quiet and in noise, duration of hearing loss, age at implantation, whether the hearing loss bilateral or single-sided and the electrode current level required to elicit MCL stimulation.
Methods: 32 adult unilateral CI users with postlingual hearing loss were enrolled. The stimuli were 1 k Hz biphasic alternating pulses and were presented at either the behaviorally measured MCL or 50% of this value (MCL0.5) via the CI fitting software. Pulses were directed to apical, medial, or basal electrodes. CAEPs were recorded from a scalp electrode placed at the vertex, low forehead, and contralateral mastoid and were evaluated by two electrophysiologists.
Results: Overall, eCAEPs could be detected in 31/32 users when stimulating at MCL, and in 29/32 users when stimulating at MCL0.5. The detection rates were 31, 31, and 28/32 for apical, medial, and basal stimulation at MCL, and 29, 29, and 26/32 at MCL0.5. Significant differences in eCAEP amplitudes and latencies were observed across electrodes and stimulation levels. No significant correlations were found between eCAEP latencies and amplitudes and user age, duration of deafness prior to CI surgery, or with bilateral versus single-sided hearing loss, nor with the charge level required to elicit MCL, or with speech perception scores in quiet. Peak latencies correlated with speech perception scores in some configurations of speech-in-noise.
Conclusion: eCAEPs can readily be elicited in the majority of adult CI users and show normal waveform characteristics at stimulation levels corresponding to MCL, as well as at basal, medial, and apical electrode stimulation sites. Neither the latencies nor amplitudes of eCAEPs are confounded by variables of age, duration of deafness prior to CI surgery, or the laterality of hearing loss. eCAEPs are a useful, objective method evaluate sound perception in CI users. Audiol Neurotol

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Event-Related Potentials of Single-Sided Deaf Cochlear Implant Users: Using a Semantic Oddball Paradigm in Noise

M Voola,A Wedekind,AT Nguyen,W Marinovic,G Rajan,D Tavora-Vieira

Publication date 20-03-2023

Introduction: In individuals with single-sided deafness (SSD), who are characterised by profound hearing loss in one ear and normal hearing in the contralateral ear, binaural input is no longer present. A cochlear implant (CI) can restore functional hearing in the profoundly deaf ear, with previous literature demonstrating improvements in speech-in-noise intelligibility with the CI. However, we currently have limited understanding of the neural processes involved (e.g., how the brain integrates the electrical signal produced by the CI with the acoustic signal produced by the normal hearing ear) and how modulation of these processes with a CI contributes to improved speech-in-noise intelligibility. Using a semantic oddball paradigm presented in the presence of background noise, this study aims to investigate how the provision of CI impacts speech-in-noise perception of SSD-CI users.
Method: Task performance (reaction time, reaction time variability, target accuracy, subjective listening effort) and high density electroencephalography from twelve SSD-CI participants were recorded, while they completed a semantic acoustic oddball task. Reaction time was defined as the time taken for a participant to press the response button after stimulus onset. All participants completed the oddball task in three different free-field conditions with the speech and noise coming from different speakers.
The three tasks were: (1) CI-On in background noise, (2) CI-Off in background noise, and (3) CI-On without background noise (Control). Task performance and electroencephalography data (N2N4 and P3b) were recorded for each condition. Speech in noise and sound localisation ability were also measured.
Results: Reaction time was significantly different between all tasks with CI-On (M SE = 809 39.9 ms) having faster RTs than CI-Off (M SE = 845 39.9 ms) and Control (M SE = 785 39.9 ms) being the fastest condition. The Control condition exhibited significantly shorter N2N4 and P3b area latency compared to the other two conditions. However, despite these differences noticed in RTs and area latency, we observed similar results between all three conditions for N2N4 and P3b difference area.
Conclusion: The inconsistency between the behavioural and neural results suggests that EEG may not be a reliable measure of cognitive effort. This rationale is further supported by different explanations used in past studies to explain N2N4 and P3b effects. Future studies should look to alternative measures of auditory processing (e.g., pupillometry) to gain a deeper understanding of the underlying auditory processes that facilitate speech-in-noise intelligibility. Audiol Neurotol

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Test-Retest Reliability of the Coordinate Response Measure in Adults with Normal Hearing or Cochlear Implants

SM Saleh,SR Saeed,D Vickers

Publication date 22-02-2023

Background: Speech perception in noise is especially challenging for cochlear implant (CI) recipients; thus, speech in noise tests are used to clinically evaluate functional hearing with CIs. The coordinate response measure (CRM) corpus can be utilized in an adaptive speech perception test with competing speakers as the masker. Determining the critical difference for CRM thresholds can enable it to be used to evaluate changes in CI outcomes for clinical and research purposes. If a change in CRM exceeds the critical difference, then this would indicate significant improvement or decrement in speech perception. Additionally, this information provides figures for power calculations that could be used for planning studies and clinical trials Bland JM: An Introduction to Medical Statistics, 2000.
Objectives: This study determined the test-retest reliability of the CRM for adults with normal hearing (NH) and adults with CIs. The replicability, variability, and repeatability of the CRM were evaluated for the two groups separately.
Method: Thirty-three NH adults and thirteen adult CI recipients were recruited and tested with the CRM twice, 1 month apart. The CI group was tested with two talkers only, while the NH group was tested with seven talkers as well as two talkers.
Results: CRM had better replicability, repeatability and lower variability for the CI adults compared to NH adults. The critical difference (at p #x3c; 0.05) in the two-talker CRM speech reception thresholds (SRTs) among CI users was #x3e;5.2 dB, and it was #x3e;6.2 dB for the NH if an individual were to be tested under two different conditions. The critical difference (at p #x3c; 0.05) in the seven-talker CRM SRT was #x3e;6.49. The Mann-Whitney U test showed that CI recipients’ CRM scores’ variance (Mdn = −0.94) was significantly less than the NH group’s (Mdn = 2.2) (U = 54, p #x3c; 0.0001). Although the NH had significantly better SRTs in the two-talker condition than in the seven-talker condition (t = −20.29, df = 65, p #x3c; 0.0001), the Wilcoxon signed ranks test showed no significant difference between the CRM scores’ variance in the two conditions (Z = −1, N = 33, p = 0.08).
Conclusions: NH adults had significantly lower CRM SRTs than the CI recipients; t (31.16) = −23.91, p #x3c; 0.001. CRM had better replicability, stability and lower variability for the CI adults compared to NH adults. Audiol Neurotol 2023;28:84–93

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The Relationship between the Characteristics of Tinnitus and the Hearing Curative Effect of Sudden Deafness

T Zou,J Xu,H Lu,M Yu

Publication date 21-02-2023

Background: Tinnitus is the most common complication of sudden deafness. There are many studies on tinnitus and tinnitus as a prognostic factor for sudden deafness.
Summary: We collected 285 cases (330 ears) of sudden deafness to investigate the relationship between tinnitus psychoacoustic characteristics and the hearing curative effective rate. The hearing curative effective rate was analyzed and compared between the patients whether it is accompanied by tinnitus, with different tinnitus frequency and different tinnitus loudness.
Key Messages: Patients with tinnitus frequency (125–2,000 Hz) and no tinnitus have better hearing efficacy, and those with high frequency tinnitus (3,000–8,000 Hz) have worse hearing efficacy. Test the tinnitus frequency of patients in the initial stage of sudden deafness has some guiding significance for the evaluation of hearing prognosis. Audiol Neurotol

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Residual Hearing Does Not Influence the Effectiveness of Beamforming when Using a Cochlear Implant in Conjunction with Contralateral Routing of Signals

HC Stronks,JJ Briaire,JHM Frijns

Publication date 15-02-2023

Introduction: Contralateral routing of signals (CROS) overcomes the head shadow effect by redirecting speech signals from the contralateral ear to the better-hearing cochlear implant (CI) ear. Here we tested the performance of an adaptive monaural beamformer (MB) and a fixed binaural beamformer (BB) using the CROS system of Advanced Bionics.
Methods: In a group of 17 unilateral CI users, we evaluated the benefits of MB and BB for speech recognition by measuring speech reception threshold (SRT) with and without beamforming. MB and BB were additionally evaluated with signal-to-noise ratio (SNR) measurements using a KEMAR manikin. We also assessed the effect of residual hearing in the CROS ear on the benefits of MB and BB. Speech was delivered in front of the listener in a background of homogeneous 8-talker babble noise.
Results: With CI-CROS in omnidirectional settings with the T-mic active on the CI as a reference, BB significantly improved SRT by 1.4 dB, whereas MB yielded no significant improvements. The difference in effects on SRT between the two beamformers was, however, not significant. SNR effects were substantially larger, at 2.1 dB for MB and 5.8 dB for BB. CI-CROS with default omnidirectional settings also improved SRT and SNR by 1 dB over CI alone. Residual hearing did not significantly affect beamformer performance.
Discussion: We recommend the use of BB over MB for CI-CROS users. Residual hearing in the CROS ear is not a limiting factor for fitting a CROS device, although a bimodal option should be considered. Audiol Neurotol

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The Diagnostic Value of Multifrequency Tympanometry in Patients with Ménière’s Disease: A Prospective Analysis

MA de Jong,BF van Esch,PPG van Benthem,HJ van der Zaag-Loonen,TD Bruintjes,HGXM Thomeer

Publication date 15-02-2023

Introduction: Diagnosing Ménière’s disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests evaluating the presence of endolymphatic hydrops (EH) are often expensive or time assuming. An in-office quick and simple non-invasive diagnostic test is multifrequency tympanometry (MFT). It can measure conductance at 2 k Hz probe tones, which was demonstrated to reflect variations in cochlear pressure. Previous studies investigating MFT as a diagnostic test for MD showed conflicting outcomes possibly biased by their retrospective design.
Methods: We prospectively collected MFT results (Y width) in patients with dizziness and compared MFT test results in affected (group 1) and unaffected (group 2) ears of 37 MD subjects and in control ears of 33 non-MD subjects (group 3).
Results: The mean value of the Y width in affected ears was 315.6 ± 70.2 da Pa compared to 292.3 ± 98.6 da Pa in unaffected ears in MD subjects and 259.4. ± 60.6 da Pa in the non-MD group. A positive test result (i.e., a Y width of 235 da Pa or more) was found in 35 ears in the MD group, 21 times involving the affected ear and 14 times involving the unaffected ear, compared to 16 in the non-MD group. No significant differences between the three groups could be demonstrated (p #x3e; 0.05). We found a sensitivity of 58.3% and specificity of 66.3% for detecting EH in an affected ear in MD subjects.
Conclusion: There is a trend towards increased conductance tympanometry in affected ears. However, we noticed a high false positive rate of MFT and do not support standardized use of MFT as an additional diagnostic tool for detecting EH in MD patients. A negative test result on the contrary is unlikely related to EH. Audiol Neurotol

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Diagnostic Value of the Air-Bone Threshold Gap in Stapes Fixation

D Cheon,D Kim,SH Kim,JY Choi,SH Bae

Publication date 08-02-2023

Introduction: The Carhart notch is a well-known sign of stapes fixation. However, previous studies have reported that the Carhart notch is not specific to stapes fixation and is also present in other middle ear diseases. Therefore, this study investigated the diagnostic value of threshold gap between air conduction and bone conduction (ABG) for stapes fixation, instead of the bone conduction dip representing the Carhart notch.
Methods: A total of 199 ears that underwent exploratory tympanotomy were enrolled in this retrospective study.
They were categorized into three groups according to surgical findings: stapes fixation (SF), other ossicle fixation (OF), and chain disconnection (CD). Preoperative pure-tone audiograms and impedance audiograms were compared between the groups.
Results: The incidence of the Carhart notch did not differ between the groups. The ABG at 2,000 Hz showed a good diagnostic performance for distinguishing between the SF and CD groups (area under the curve, AUC = 0.816, p #x3c; 0.001), but poor performance for distinguishing between the SF and OF groups (AUC = 0.662, p = 0.003). Bone conduction at 2,000 Hz showed a moderate performance for distinguishing between the SF and CD groups (AUC = 0.707, p #x3c; 0.001) and did not show statistically significant results for distinguishing between the SF and OF groups (AUC = 0.594, p = 0.080). The tympanic membrane compliance was significantly higher in the CD group than in the SF group (p = 0.001).
Conclusions: The Carhart notch was not a specific finding of SF. The sensitivity and specificity of ABG ≤15 dB at 2,000 Hz for distinguishing between SF and CD were 60.4% and 89.2%, respectively. To prepare for surgical interventions in patients with conductive hearing loss but a normal tympanic membrane, clinicians should comprehensively consider these results. Audiol Neurotol

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Binaural Hearing Using the ADHEAR Bone Conduction System in the Monaurally Occluded Ear

A Canale,D Ndrev,F Macocco,R Albera,G Aschero,S Lovallo,M Gragnano,G Scozzari,A Albera

Publication date 07-02-2023

Introduction: The study aimed to investigate binaural cues in the rehabilitation of unilateral occluded ears with a bone conduction hearing aid.
Methods: The study sample consisted of 40 adult volunteers with normal hearing. Unilateral pseudo-conductive hearing loss was induced by inserting an earplug into the external auditory canal (EAC) and silicone material in the concha for ear impression. The adaptive speech-in-noise test (Italian Matrix test) was performed in three spatial orientations to assess binaural cues (summation, squelch, and head shadow effects). All evaluations were performed in the normal condition, after EAC occlusion, and after application of an adhesive bone conduction hearing aid. Binaural contrast differences were calculated in the three conditions.
Results: In the EAC occlusion condition, there was a significant increase in the signal-to-noise ratio (SNR) in both the S0N0 (2.4 dB) and the S90N−90 (7.7 dB) settings, and a slight albeit significant increase in the S0N90 setting (1.35 dB). After fitting the BC hearing aid, there was a reduction of −1.8 dB SNR (p #x3c; 0.001) in the S0N0 setting and −2 dB (p = 0.003) in the S90N−90 setting. There was no improvement in the SNR (p = 0.405) in evaluation of the squelch effect (S0N90). These data were corroborated by a better binaural contrast due to a reduction in the summation effect in the monaural occlusion condition and a subsequent reduction in binaural contrast after fitting the hearing aid due to an increase in the summation effect (−2.5 dB vs. 0.3 dB; p #x3c; 0.001).
Conclusions: Application of a bone conduction hearing aid in unilateral pseudo-conductive hearing loss strengthens speech recognition of noise by improving the summation effect and impeding the shadow effect of the head; however, there appears to be no improvement in speech perception in noise due to spatial release from masking. Audiol Neurotol

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Vestibulotoxicity in Patients Undergoing Cisplatin-Based Cancer Treatment: A Phase IIIB Randomized Controlled Clinical Trial

I Moreno,A Belinchon

Publication date 02-02-2023

Introduction: This study aimed to evaluate the incidence of balance disorders and the efficacy of dexamethasone in protecting patients undergoing cisplatin-based cancer treatment against vestibulototoxicity.
Methods: This study was a randomized controlled phase IIIB clinical trial. The subjects participating in the clinical trial were patients with a neoplastic disease whose treatment protocol included cisplatin. The average dose of cisplatin was 444.87 mg (SD 235.2 mg). Treatment consisted of intratympanically administering dexamethasone via a passive diffusion device called Microwick (8 mg/24 h dose) from the start of treatment with cisplatin to 3 weeks after the last cycle. Patients were administered the medication to one ear, and the contralateral ear was used as the control. The treated ears were randomly chosen using a computer system (randomization). Vestibular system was evaluated by video head impulse test before each cisplatin cycle.
Results: Thirty-four patients were recruited over a 2-year period at a reference tertiary hospital, of whom 11 were excluded. Forty-six ears were analyzed (23 treated and 23 control ears). Vestibular analysis presented no changes in the mean increase in the vestibulo-ocular response in all patients evaluated, both in treated and control ears. Both 8.69% infection complications during treatment and 34.8% permanent perforation at 6 months were detected after device removal.
Conclusion: Ototoxicity related to cisplatin-based treatment does not affect the vestibular system. Long-term high-dose intratympanic dexamethasone treatment is safe for the vestibular system. Audiol Neurotol

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Correlations of Clinical and Audio-Vestibulometric Findings with Coexisting Anxiety and Depression in Ménière’s Disease Patients

B Subasi,N Yildirim,ZY Akbey,NE Karaman,O Arik

Publication date 19-01-2023

Introduction: Ménière’s disease (MD) is an inner ear disorder, characterized by vertiginous attacks, fluctuating sensorineural hearing loss, tinnitus, and a feeling of ear fullness. Endolymphatic hydrops has been proven as the underlying pathology. Frequently, psychopathologies accompany the disease. The aim of this study was to investigate the correlation of anxiety and depression with demographic, clinical, and audio-vestibular findings in MD patients.
Methods: The study included 40 consecutive unilateral MD patients. Demographic data (age, sex, education, employment, and marital status), clinical variables of drop attacks, the duration, frequency and severity of vertigo attacks, and tinnitus disturbance levels were recorded. Hearing threshold levels were graded between 1 and 4. Vestibulometric variables were taken as the presence of saccades and vestibulo-ocular reflex (VOR) gain deficits in the video head impulse tests (vHIT) and canal paresis in bithermal caloric tests. Becks’s depression and anxiety scales were used for psychometric evaluations and graded by 4 and 5 from normal to severe and normal to very severe, respectively.
Results: The median age of the patients was 48.94 years, and the numbers of both sexes were almost equal (male/female = 19/21). All patients reported at least one vertigo attacks within the last year. The duration of attacks was most commonly (62.5%) 1–3 h, ranging from #x3c;1 h to 17 h. Most attacks were graded as mild (67.5%), and the frequency was 2–3 episodes per year in 22 (55%) patients. The number of attacks within the last year was 1–12. Three patients reported having drop attacks. Hearing loss in the affected ear was moderate/moderately severe in 20 (50%) patients. Thirty-seven (92.5%) patients had complaints of tinnitus. In vHIT, saccades and VOR gain deficits were found in 33 (82.5%) and 11 (27.5%) patients, respectively. Canal paresis was present in 18 (45%) patients. The depression and anxiety rates were 35% and 90%, respectively. Depression scores were correlated with education, marital status, and the presence of saccades. Anxiety was correlated only with tinnitus severity and VOR gain deficits. Depression and anxiety were also correlated.
Conclusion: Vertigo appears to be more intrusive than the other MD symptoms, and a higher correlation with anxiety than depression was demonstrated in this cohort. However, depression was seen less among married and educated patients, suggesting the role of coping capability, and had more pronounced clinical/vestibulometric correlates. Overall, these results indicated that it is mainly the severity of organic/physiological pathology which determines the degree of depression and anxiety in MD rather than vice versa. Audiol Neurotol 2023;28:75–83

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