Cross-modal functional connectivity supports speech understanding in cochlear implant users

Sensory deprivation can lead to cross-modal cortical changes, whereby sensory brain regions deprived of input may be recruited to perform atypical function. Enhanced cross-modal responses to visual stimuli observed in auditory cortex of postlingually deaf cochlear implant (CI) users are hypothesized to reflect increased activation of cortical language regions, but it is unclear if this cross-modal activity is adaptive or mal-adaptive for speech understanding. To determine if increased activation of language regions is correlated with better speech understanding in CI users, we assessed task-related activation and functional connectivity of auditory and visual cortices to auditory and visual speech and non-speech stimuli in CI users (n = 14) and normal-hearing listeners (n = 17) and used functional near-infrared spectroscopy to measure hemodynamic responses. We used visually presented speech and non-speech to investigate neural processes related to linguistic content and observed that CI users show beneficial cross-modal effects. Specifically, an increase in connectivity between the left auditory and visual cortices-presumed primary sites of cortical language processing-was positively correlated with CI users\u27 abilities to understand speech in background noise. Cross-modal activity in auditory cortex of postlingually deaf CI users may reflect adaptive activity of a distributed, multimodal speech network, recruited to enhance speech understanding

Use of Functional Near-Infrared Spectroscopy to Predict and Measure Cochlear Implant Outcomes: A Scoping Review

Outcomes following cochlear implantation vary widely for both adults and children, and behavioral tests are currently relied upon to assess this. However, these behavioral tests rely on subjective judgements that can be unreliable, particularly for infants and young children. The addition of an objective test of outcome following cochlear implantation is therefore desirable. The aim of this scoping review was to comprehensively catalogue the evidence for the potential of functional near infrared spectroscopy (fNIRS) to be used as a tool to objectively predict and measure cochlear implant outcomes. A scoping review of the literature was conducted following the PRISMA extension for scoping review framework. Searches were conducted in the MEDLINE, EMBASE, PubMed, CINAHL, SCOPUS, and Web of Science electronic databases, with a hand search conducted in Google Scholar. Key terms relating to near infrared spectroscopy and cochlear implants were used to identify relevant publications. Eight records met the criteria for inclusion. Seven records reported on adult populations, with five records only including post-lingually deaf individuals and two including both pre- and post-lingually deaf individuals. Studies were either longitudinal or cross-sectional, and all studies compared fNIRS measurements with receptive speech outcomes. This review identified and collated key work in this field. The homogeneity of the populations studied so far identifies key gaps for future research, including the use of fNIRS in infants. By mapping the literature on this important topic, this review contributes knowledge towards the improvement of outcomes following cochlear implantation

Audiovisual speech perception in cochlear implant patients

Hearing with a cochlear implant (CI) is very different compared to a normal-hearing (NH) experience, as the CI can only provide limited auditory input. Nevertheless, the central auditory system is capable of learning how to interpret such limited auditory input such that it can extract meaningful information within a few months after implant switch-on. The capacity of the auditory cortex to adapt to new auditory stimuli is an example of intra-modal plasticity — changes within a sensory cortical region as a result of altered statistics of the respective sensory input. However, hearing deprivation before implantation and restoration of hearing capacities after implantation can also induce cross-modal plasticity — changes within a sensory cortical region as a result of altered statistics of a different sensory input. Thereby, a preserved cortical region can, for example, support a deprived cortical region, as in the case of CI users which have been shown to exhibit cross-modal visual-cortex activation for purely auditory stimuli. Before implantation, during the period of hearing deprivation, CI users typically rely on additional visual cues like lip-movements for understanding speech. Therefore, it has been suggested that CI users show a pronounced binding of the auditory and visual systems, which may allow them to integrate auditory and visual speech information more efficiently. The projects included in this thesis investigate auditory, and particularly audiovisual speech processing in CI users. Four event-related potential (ERP) studies approach the matter from different perspectives, each with a distinct focus. The first project investigates how audiovisually presented syllables are processed by CI users with bilateral hearing loss compared to NH controls. Previous ERP studies employing non-linguistic stimuli and studies using different neuroimaging techniques found distinct audiovisual interactions in CI users. However, the precise timecourse of cross-modal visual-cortex recruitment and enhanced audiovisual interaction for speech related stimuli is unknown. With our ERP study we fill this gap, and we present differences in the timecourse of audiovisual interactions as well as in cortical source configurations between CI users and NH controls. The second study focuses on auditory processing in single-sided deaf (SSD) CI users. SSD CI patients experience a maximally asymmetric hearing condition, as they have a CI on one ear and a contralateral NH ear. Despite the intact ear, several behavioural studies have demonstrated a variety of beneficial effects of restoring binaural hearing, but there are only few ERP studies which investigate auditory processing in SSD CI users. Our study investigates whether the side of implantation affects auditory processing and whether auditory processing via the NH ear of SSD CI users works similarly as in NH controls. Given the distinct hearing conditions of SSD CI users, the question arises whether there are any quantifiable differences between CI user with unilateral hearing loss and bilateral hearing loss. In general, ERP studies on SSD CI users are rather scarce, and there is no study on audiovisual processing in particular. Furthermore, there are no reports on lip-reading abilities of SSD CI users. To this end, in the third project we extend the first study by including SSD CI users as a third experimental group. The study discusses both differences and similarities between CI users with bilateral hearing loss and CI users with unilateral hearing loss as well as NH controls and provides — for the first time — insights into audiovisual interactions in SSD CI users. The fourth project investigates the influence of background noise on audiovisual interactions in CI users and whether a noise-reduction algorithm can modulate these interactions. It is known that in environments with competing background noise listeners generally rely more strongly on visual cues for understanding speech and that such situations are particularly difficult for CI users. As shown in previous auditory behavioural studies, the recently introduced noise-reduction algorithm "ForwardFocus" can be a useful aid in such cases. However, the questions whether employing the algorithm is beneficial in audiovisual conditions as well and whether using the algorithm has a measurable effect on cortical processing have not been investigated yet. In this ERP study, we address these questions with an auditory and audiovisual syllable discrimination task. Taken together, the projects included in this thesis contribute to a better understanding of auditory and especially audiovisual speech processing in CI users, revealing distinct processing strategies employed to overcome the limited input provided by a CI. The results have clinical implications, as they suggest that clinical hearing assessments, which are currently purely auditory, should be extended to audiovisual assessments. Furthermore, they imply that rehabilitation including audiovisual training methods may be beneficial for all CI user groups for quickly achieving the most effective CI implantation outcome

Dynamic networks differentiate the language ability of children with cochlear implants

Background: Cochlear implantation (CI) in prelingually deafened children has been shown to be an effective intervention for developing language and reading skill. However, there is a substantial proportion of the children receiving CI who struggle with language and reading. The current study–one of the first to implement electrical source imaging in CI population was designed to identify the neural underpinnings in two groups of CI children with good and poor language and reading skill. Methods: Data using high density electroencephalography (EEG) under a resting state condition was obtained from 75 children, 50 with CIs having good (HL) or poor language skills (LL) and 25 normal hearing (NH) children. We identified coherent sources using dynamic imaging of coherent sources (DICS) and their effective connectivity computing time-frequency causality estimation based on temporal partial directed coherence (TPDC) in the two CI groups compared to a cohort of age and gender matched NH children. Findings: Sources with higher coherence amplitude were observed in three frequency bands (alpha, beta and gamma) for the CI groups when compared to normal hearing children. The two groups of CI children with good (HL) and poor (LL) language ability exhibited not only different cortical and subcortical source profiles but also distinct effective connectivity between them. Additionally, a support vector machine (SVM) algorithm using these sources and their connectivity patterns for each CI group across the three frequency bands was able to predict the language and reading scores with high accuracy. Interpretation: Increased coherence in the CI groups suggest overall that the oscillatory activity in some brain areas become more strongly coupled compared to the NH group. Moreover, the different sources and their connectivity patterns and their association to language and reading skill in both groups, suggest a compensatory adaptation that either facilitated or impeded language and reading development. The neural differences in the two groups of CI children may reflect potential biomarkers for predicting outcome success in CI children

Physiology, Psychoacoustics and Cognition in Normal and Impaired Hearing

otorhinolaryngology; neurosciences; hearin

Physiology, Psychoacoustics and Cognition in Normal and Impaired Hearing

​The International Symposium on Hearing is a prestigious, triennial gathering where world-class scientists present and discuss the most recent advances in the field of human and animal hearing research. The 2015 edition will particularly focus on integrative approaches linking physiological, psychophysical and cognitive aspects of normal and impaired hearing. Like previous editions, the proceedings will contain about 50 chapters ranging from basic to applied research, and of interest to neuroscientists, psychologists, audiologists, engineers, otolaryngologists, and artificial intelligence researchers.