Evaluation of Auditory Evoked Potentials as a Hearing aid Outcome Measure

This thesis aimed to explore the applicability of Cortical Auditory Evoked Potentials (CAEPs) and Envelope Following Responses (EFRs) as objective aided outcome measures for use in infants wearing hearing aids. The goals for CAEP-related projects were to evaluate the effect of speech stimulus source on CAEPs, non-linear hearing aid processing on tone-evoked CAEPs, and the effect of inter-stimulus intervals on non-linear hearing aid processing of phonemes. Results illustrated larger amplitude CAEPs with shorter latencies for speech stimuli from word-medial positions than word-initial positions, and no significant effect of the tone burst onset overshoot due to non-linear hearing aid processing. Inter-stimulus intervals in CAEP protocols resulted in significantly lower aided phoneme levels compared to when they occurred in running speech, illustrating potential inaccuracies in representation of relevant hearing aid function during testing. The major contribution of this thesis includes the proposal and validation of a test paradigm based on speech-evoked EFRs for use as an objective aided outcome measure. The stimulus is a naturally spoken token /susashi/ modified to enable recording of eight EFRs from low, mid and high frequency regions. The projects aimed to evaluate previously recommended response analysis methods of averaging responses to opposite polarities for vowel-evoked EFRs as well as sensitivity of the proposed paradigm to changes in audibility due to level and bandwidth in adults with normal hearing and additionally, due to amplification in adults with hearing loss. Results demonstrated a vowel-specific effect of averaging opposite polarity responses when the first harmonic was present, however the averaging did not affect detection in the majority of participants. The EFR test paradigm illustrated carrier-specific changes in audibility due to level, bandwidth and amplification suggesting that the paradigm may be a useful tool in evaluating unaided and aided audibility, and therefore appropriateness of hearing aid fittings. Further validation is necessary in infants and children wearing hearing aids. In conclusion, CAEPs and EFRs vary in strengths and limitations, and therefore it is likely that a combination of measures may be necessary to address the variety of hearing disorders seen in a typical audiological caseload

Hearing Aids Reduce Daily-Life Fatigue and Increase Social Activity: A Longitudinal Study

People with hearing loss experience fatigue, and it is unknown whether this is alleviated by treatment with hearing aids. The objective of this study was to address this issue and to investigate the possible concomitant effect of hearing-aid fitting on activity levels. An intervention group (n = 53) who were due to be fitted with their first-ever hearing aid(s) and a control group (n = 53) who had hearing loss but no change in hearing aid status–completed a battery of self-report outcome measures four times: once before fitting, and at 2 weeks, 3 months, and 6 months post fitting. Self-report outcome measures at each assessment captured fatigue, listening effort, hearing handicap, auditory lifestyle, social participation restrictions, and work, social and physical activity levels. Hearing-aid fitting led to a significant reduction in listening-related fatigue, but not general fatigue, in the intervention group compared to the control group. Additionally, social activity level increased and social participation restriction decreased significantly after hearing aid fitting in the intervention group compared to the control group. No significant interaction was found between working status and change in listening-related fatigue score. This study is the first to make a longitudinal measurement of fatigue before and after first-ever hearing aid fitting and to identify an increase in social activity level after hearing aid fitting. These findings have important implications for future research and the clinical practice of hearing aid fitting

A tutorial on implantable hearing amplification options for adults with unilateral microtia and atresia

published_or_final_versio

Applicability of subcortical EEG metrics of synaptopathy to older listeners with impaired audiograms

Emerging evidence suggests that cochlear synaptopathy is a common feature of sensorineural hearing loss, but it is not known to what extent electrophysiological metrics targeting synaptopathy in animals can be applied to people, such as those with impaired audiograms. This study investigates the applicability of subcortical electrophysiological measures associated with synaptopathy, i.e., auditory brainstem responses (ABRs) and envelope following responses (EFRs), to older participants with high-frequency sloping audiograms. The outcomes of this study are important for the development of reliable and sensitive synaptopathy diagnostics in people with normal or impaired outer-hair-cell function. Click-ABRs at different sound pressure levels and EFRs to amplitude-modulated stimuli were recorded, as well as relative EFR and ABR metrics which reduce the influence of individual factors such as head size and noise floor level on the measures. Most tested metrics showed significant differences between the groups and did not always follow the trends expected from synaptopathy. Age was not a reliable predictor for the electrophysiological metrics in the older hearing-impaired group or young normal-hearing control group. This study contributes to a better understanding of how electrophysiological synaptopathy metrics differ in ears with healthy and impaired audiograms, which is an important first step towards unravelling the perceptual consequences of synaptopathy.(C) 2019 Elsevier B.V. All rights reserved

Hidden Hearing Loss Impacts the Neural Representation of Speech in Background Noise

Many individuals with seemingly normal hearing abilities struggle to understand speech in noisy backgrounds. To understand why this might be the case, we investigated the neural representation of speech in the auditory midbrain of gerbils with “hidden hearing loss” through noise exposure that increased hearing thresholds only temporarily. In noise-exposed animals, we observed significantly increased neural responses to speech stimuli, with a more pronounced increase at moderate than at high sound intensities. Noise exposure reduced discriminability of neural responses to speech in background noise at high sound intensities, with impairment most severe for tokens with relatively greater spectral energy in the noise-exposure frequency range (2–4 kHz). At moderate sound intensities, discriminability was surprisingly improved, which was unrelated to spectral content. A model combining damage to high-threshold auditory nerve fibers with increased response gain of central auditory neurons reproduced these effects, demonstrating that a specific combination of peripheral damage and central compensation could explain listening difficulties despite normal hearing thresholds

Comprehensive Audiometric Analysis of Hearing Impairment and Tinnitus After Cisplatin-Based Chemotherapy in Survivors of Adult-Onset Cancer.

PURPOSE: Cisplatin is widely used but highly ototoxic. Effects of cumulative cisplatin dose on hearing loss have not been comprehensively evaluated in survivors of adult-onset cancer. PATIENTS AND METHODS: Comprehensive audiological measures were conducted on 488 North American male germ cell tumor (GCT) survivors in relation to cumulative cisplatin dose, including audiograms (0.25 to 12 kHz), tests of middle ear function, and tinnitus. American Speech-Language-Hearing Association criteria defined hearing loss severity. The geometric mean of hearing thresholds (0.25 to 12 kHz) summarized overall hearing status consistent with audiometric guidelines. Patients were sorted into quartiles of hearing thresholds of age- and sex-matched controls. RESULTS: Increasing cumulative cisplatin dose (median, 400 mg/m(2); range, 200 to 800 mg/m(2)) was significantly related to hearing loss at 4, 6, 8, 10, and 12 kHz (P trends, .021 to \u3c .001): every 100 mg/m(2) increase resulted in a 3.2-dB impairment in age-adjusted overall hearing threshold (4 to 12 kHz; P \u3c .001). Cumulative cisplatin doses \u3e 300 mg/m(2) were associated with greater American Speech-Language-Hearing Association-defined hearing loss severity (odds ratio, 1.59; P = .0066) and worse normative-matched quartiles (odds ratio, 1.33; P = .093) compared with smaller doses. Almost one in five (18%) patients had severe to profound hearing loss. Tinnitus (40% patients) was significantly correlated with reduced hearing at each frequency (P \u3c .001). Noise-induced damage (10% patients) was unaffected by cisplatin dose (P = .59). Hypertension was significantly related (P = .0066) to overall hearing threshold (4 to 12 kHz) in age- and cisplatin dose-adjusted analyses. Middle ear deficits occurred in 22.3% of patients but, as expected, were not related to cytotoxic drug dosage. CONCLUSION: Follow-up of adult-onset cancer survivors given cisplatin should include routine inquiry for hearing status and tinnitus, referral to audiologists as clinically indicated, and hypertension control. Patients should be urged to avoid noise exposure, ototoxic drugs, and other factors that further damage hearing

Proceedings of the Linux Audio Conference 2018

These proceedings contain all papers presented at the Linux Audio Conference 2018. The conference took place at c-base, Berlin, from June 7th - 10th, 2018 and was organized in cooperation with the Electronic Music Studio at TU Berlin

Biophysical modeling of a cochlear implant system: progress on closed-loop design using a novel patient-specific evaluation platform

The modern cochlear implant is one of the most successful neural stimulation devices, which partially mimics the workings of the auditory periphery. In the last few decades it has created a paradigm shift in hearing restoration of the deaf population, which has led to more than 324,000 cochlear implant users today. Despite its great success there is great disparity in patient outcomes without clear understanding of the aetiology of this variance in implant performance. Furthermore speech recognition in adverse conditions or music appreciation is still not attainable with today's commercial technology. This motivates the research for the next generation of cochlear implants that takes advantage of recent developments in electronics, neuroscience, nanotechnology, micro-mechanics, polymer chemistry and molecular biology to deliver high fidelity sound. The main difficulties in determining the root of the problem in the cases where the cochlear implant does not perform well are two fold: first there is not a clear paradigm on how the electrical stimulation is perceived as sound by the brain, and second there is limited understanding on the plasticity effects, or learning, of the brain in response to electrical stimulation. These significant knowledge limitations impede the design of novel cochlear implant technologies, as the technical specifications that can lead to better performing implants remain undefined. The motivation of the work presented in this thesis is to compare and contrast the cochlear implant neural stimulation with the operation of the physiological healthy auditory periphery up to the level of the auditory nerve. As such design of novel cochlear implant systems can become feasible by gaining insight on the question `how well does a specific cochlear implant system approximate the healthy auditory periphery?' circumventing the necessity of complete understanding of the brain's comprehension of patterned electrical stimulation delivered from a generic cochlear implant device. A computational model, termed Digital Cochlea Stimulation and Evaluation Tool (‘DiCoStET’) has been developed to provide an objective estimate of cochlear implant performance based on neuronal activation measures, such as vector strength and average activation. A patient-specific cochlea 3D geometry is generated using a model derived by a single anatomical measurement from a patient, using non-invasive high resolution computed tomography (HRCT), and anatomically invariant human metrics and relations. Human measurements of the neuron route within the inner ear enable an innervation pattern to be modelled which joins the space from the organ of Corti to the spiral ganglion subsequently descending into the auditory nerve bundle. An electrode is inserted in the cochlea at a depth that is determined by the user of the tool. The geometric relation between the stimulation sites on the electrode and the spiral ganglion are used to estimate an activating function that will be unique for the specific patient's cochlear shape and electrode placement. This `transfer function', so to speak, between electrode and spiral ganglion serves as a `digital patient' for validating novel cochlear implant systems. The novel computational tool is intended for use by bioengineers, surgeons, audiologists and neuroscientists alike. In addition to ‘DiCoStET’ a second computational model is presented in this thesis aiming at enhancing the understanding of the physiological mechanisms of hearing, specifically the workings of the auditory synapse. The purpose of this model is to provide insight on the sound encoding mechanisms of the synapse. A hypothetical mechanism is suggested in the release of neurotransmitter vesicles that permits the auditory synapse to encode temporal patterns of sound separately from sound intensity. DiCoStET was used to examine the performance of two different types of filters used for spectral analysis in the cochlear implant system, the Gammatone type filter and the Butterworth type filter. The model outputs suggest that the Gammatone type filter performs better than the Butterworth type filter. Furthermore two stimulation strategies, the Continuous Interleaved Stimulation (CIS) and Asynchronous Interleaved Stimulation (AIS) have been compared. The estimated neuronal stimulation spatiotemporal patterns for each strategy suggest that the overall stimulation pattern is not greatly affected by the temporal sequence change. However the finer detail of neuronal activation is different between the two strategies, and when compared to healthy neuronal activation patterns the conjecture is made that the sequential stimulation of CIS hinders the transmission of sound fine structure information to the brain. The effect of the two models developed is the feasibility of collaborative work emanating from various disciplines; especially electrical engineering, auditory physiology and neuroscience for the development of novel cochlear implant systems. This is achieved by using the concept of a `digital patient' whose artificial neuronal activation is compared to a healthy scenario in a computationally efficient manner to allow practical simulation times.Open Acces

Communication with diminutives to young children vs. pets in German, Italian, Lithuanian, Russian, and English

This contribution is dedicated to Steven Gillis with whom we have collaborated since the nineties within the “Crosslinguistic Project on Pre- and Protomorphology in Language Acquisition” on both child speech (CS) and child-directed speech (CDS) and also about the development of diminutives (DIMs). We investigate parallels in the use of DIMs and of hypocoristics (HYPs) between CDS and pet-directed speech (PDS), whereas CS is only marginally dealt with. When relevant, also adult-directed speech (ADS), written or oral (especially from electronic corpora, wherever available) will be compared. The presuppositions of this investigation will be stated at the beginning of the Introduction (§ 1). This involves several innovations (beyond descriptions of new data), when compared with existing literature, relevant to theoretical and typological problem areas. We will show that also in DIMs and HYPs used in CDS and PDS semantics only plays a partial or even marginal role when using more DIMs to communicate with young children and young and/or small pets, because it is more relevant that both younger and smaller pets are emotionally closer to us, which is again a pragmatic factor. In regard to language typology, we will apply our concepts of morphological richness and productivity, as argued for and supported in our previous publications, to CDS and PDS and show that richer and more productive patterns of DIM formation of a language also have a typological impact on more frequent and more productive use both in CDS and PDS. We will also apply our concepts of grading morphosemantic transparency/opacity, as argued for and supported in our previous publications, and we start to show, as al- ready shown for CS, that also in CDS towards young children (and similarly in PDS) more morphosemantically transparent DIMs are used than in ADS. This is also connected to their predominantly pragmatic meanings in CDS and PDS (obviously not exclusively pragmatic as in early CS). The languages and authors were selected according to who among the participants in the Crosslinguistic Project on Pre- and Protomorphology in Language Acquisition had CDS and PDS available, plus Elisa Mattiello who has collected English and Italian PDS data.Dit artikel gaat over het gebruik van verkleinwoorden en koosnamen (hypocoristics) in twee taalregisters: taal gericht tot kinderen (child-directed speech, CDS) en taal gericht tot huisdieren (pet-directed speech, PDS). De semantiek van verkleinwoorden blijkt een minder grote rol te spelen dan de pragmatiek: de emotionele nabijheid van kinderen en huisdieren. De studie, waarin vijf talen worden vergeleken, verkent ook de typolo- gie: de morfologische rijkdom van verkleinwoorden in een taal beïnvloedt de produc- tie.Daarnaast speelt de semantische transparantie van verkleinwoorden crosslinguïs- tisch een rol. In CDS en PDS worden meer transparante verkleinwoorden gebruikt

Efficient Acquisition and Denoising of Full-Range Event-Related Potentials Following Transient Stimulation of the Auditory Pathway

This body of work relates to recent advances in the field of human auditory event-related potentials (ERP), specifically the fast, deconvolution-based ERP acquisition as well as single-response based preprocessing, denoising and subsequent analysis methods. Its goal is the contribution of a cohesive set of methods facilitating the fast, reliable acquisition of the whole electrophysiological response generated by the auditory pathway from the brainstem to the cortex following transient acoustical stimulation. The present manuscript is divided into three sequential areas of investigation : First, the general feasibility of simultaneously acquiring auditory brainstem, middle-latency and late ERP single responses is demonstrated using recordings from 15 normal hearing subjects. Favourable acquisition parameters (i.e., sampling rate, bandpass filter settings and interstimulus intervals) are established, followed by signal analysis of the resulting ERP in terms of their dominant intrinsic scales to determine the properties of an optimal signal representation with maximally reduced sample count by means of nonlinear resampling on a logarithmic timebase. This way, a compression ratio of 16.59 is achieved. Time-scale analysis of the linear-time and logarithmic-time ERP single responses is employed to demonstrate that no important information is lost during compressive resampling, which is additionally supported by a comparative evaluation of the resulting average waveforms - here, all prominent waves remain visible, with their characteristic latencies and amplitudes remaining essentially unaffected by the resampling process. The linear-time and resampled logarithmic-time signal representations are comparatively investigated regarding their susceptibility to the types of physiological and technical noise frequently contaminating ERP recordings. While in principle there already exists a plethora of well-investigated approaches towards the denoising of ERP single-response representations to improve signal quality and/or reduce necessary aquisition times, the substantially altered noise characteristics of the obtained, resampled logarithmic-time single response representations as opposed to their linear-time equivalent necessitates a reevaluation of the available methods on this type of data. Additionally, two novel, efficient denoising algorithms based on transform coefficient manipulation in the sinogram domain and on an analytic, discrete wavelet filterbank are proposed and subjected to a comparative performance evaluation together with two established denoising methods. To facilitate a thorough comparison, the real-world ERP dataset obtained in the first part of this work is employed alongside synthetic data generated using a phenomenological ERP model evaluated at different signal-to-noise ratios (SNR), with individual gains in multiple outcome metrics being used to objectively assess algorithm performances. Results suggest the proposed denoising algorithms to substantially outperform the state-of-the-art methods in terms of the employed outcome metrics as well as their respective processing times. Furthermore, an efficient stimulus sequence optimization method for use with deconvolution-based ERP acquisition methods is introduced, which achieves consistent noise attenuation within a broad designated frequency range. A novel stimulus presentation paradigm for the fast, interleaved acquisition of auditory brainstem, middle-latency and late responses featuring alternating periods of optimized, high-rate deconvolution sequences and subsequent low-rate stimulation is proposed and investigated in 20 normal hearing subjects. Deconvolved sequence responses containing early and middle-latency ERP components are fused with subsequent late responses using a time-frequency resolved weighted averaging method based on cross-trial regularity, yielding a uniform SNR of the full-range auditory ERP across investigated timescales. Obtained average ERP waveforms exhibit morphologies consistent with both literature values and the reference recordings obtained in the first part of this manuscript, with all prominent waves being visible in the grand average waveforms. The novel stimulation approach cuts acquisition time by a factor of 3.4 while at the same time yielding a substantial gain in the SNR of obtained ERP data. Results suggest the proposed interleaved stimulus presentation and associated postprocessing methodology to be suitable for the fast, reliable extraction of full-range neural correlates of auditory processing in future studies.Diese Arbeit steht im Zusammenhang mit aktuellen Entwicklungen auf dem Gebiet der ereigniskorrelierten Potentiale (EKP) des humanen auditorischen Systems, insbesondere der schnellen, entfaltungsbasierten EKP-Aufzeichnung sowie einzelantwortbasierten Vorverarbeitungs-, Entrauschungs- und nachgelagerten Analysemethoden. Ziel ist die Bereitstellung eines vollständigen Methodensatzes, der eine schnelle, zuverlässige Erfassung der gesamten elektrophysiologischen Aktivität entlang der Hörbahn vom Hirnstamm bis zum Cortex ermöglicht, die als Folge transienter akustischer Stimulation auftritt. Das vorliegende Manuskript gliedert sich in drei aufeinander aufbauende Untersuchungsbereiche : Zunächst wird die generelle Machbarkeit der gleichzeitigen Aufzeichnung von Einzelantworten der auditorischen Hirnstammpotentiale zusammen mit mittelspäten und späten EKP anhand von Referenzmessungen an 15 normalhörenden Probanden demonstriert. Es werden hierzu geeignete Erfassungsparameter (Abtastrate, Bandpassfiltereinstellungen und Interstimulusintervalle) ermittelt, gefolgt von einer Signalanalyse der resultierenden EKP im Hinblick auf deren dominante intrinsische Skalen, um auf dieser Grundlage die Eigenschaften einer optimalen Signaldarstellung mit maximal reduzierter Anzahl an Abtastpunkten zu bestimmen, die durch nichtlineare Neuabtastung auf eine logarithmische Zeitbasis realisiert wird. Hierbei wird ein Kompressionsverhältnis von 16.59 erzielt. Zeit-Skalen-Analysen der uniform und logarithmisch abgetasteten EKP-Einzelantworten zeigen, dass bei der kompressiven Neuabtastung keine relevante Information verloren geht, was durch eine vergleichende Auswertung der resultierenden, gemittelten Wellenformen zusätzlich gestützt wird - alle prominenten Wellen bleiben sichtbar und sind hinsichtlich ihrer charakteristischen Latenzen und Amplituden von der Neuabtastung weitgehend unbeeinflusst. Die uniforme und logarithmische Signalrepräsentation werden hinsichtlich ihrer Anfälligkeit für die üblicherweise bei der EKP-Aufzeichnung auftretenden physiologischen und technischen Störquellen vergleichend untersucht. Obwohl bereits eine Fülle von gut etablierten Ansätzen für die Entrauschung von EKP-Einzelantwortdarstellungen zur Verbesserung der Signalqualität und/oder zur Reduktion der benötigten Erfassungszeiten existiert, erfordern die wesentlich veränderten Störeigenschaften der vorliegenden, logarithmisch abgetasteten Einzelantwortdarstellungen im Gegensatz zu ihrem uniformen Äquivalent eine Neubewertung der verfügbaren Methoden für diese Art von Daten. Darüber hinaus werden zwei neuartige, effiziente Entrauschungsalgorithmen geboten, die auf der Koeffizientenmanipulation einer Sinogramm-Repräsentation bzw. einer analytischen, diskreten Wavelet-Zerlegung der Einzelantworten basieren und gemeinsam mit zwei etablierten Entrauschungsmethoden einer vergleichenden Leistungsbewertung unterzogen werden. Um einen umfassenden Vergleich zu ermöglichen, werden der im ersten Teil dieser Arbeit erhaltene EKP-Messdatensatz sowie synthetischen Daten eingesetzt, die mithilfe eines phänomenologischen EKP-Modells bei verschiedenen Signal-Rausch-Abständen (SRA) erzeugt wurden, wobei die individuellen Anstiege in mehreren Zielmetriken zur objektiven Bewertung der Performanz herangezogen werden. Die erhaltenen Ergebnisse deuten darauf hin, dass die vorgeschlagenen Entrauschungsalgorithmen die etablierten Methoden sowohl in den eingesetzten Zielmetriken als auch mit Blick auf die Laufzeiten deutlich übertreffen. Weiterhin wird ein effizientes Reizsequenzoptimierungsverfahren für den Einsatz mit entfaltungsbasierten EKP-Aufzeichnungsmethoden vorgestellt, das eine konsistente Rauschunterdrückung innerhalb eines breiten Frequenzbands erreicht. Ein neuartiges Stimulus-Präsentationsparadigma für die schnelle, verschachtelte Erfassung auditorischer Hirnstammpotentiale, mittlelspäter und später Antworten durch alternierende Darbietung von optimierten, dichter Stimulussequenzen und nachgelagerter, langsamer Einzelstimulation wird eingeführt und in 20 normalhörenden Probanden evaluiert. Entfaltete Sequenzantworten, die frühe und mittlere EKP enthalten, werden mit den nachfolgenden späten Antworten fusioniert, wobei eine Zeit-Frequenz-aufgelöste, gewichtete Mittelung unter Berücksichtigung von Regularität über Einzelantworten hinweg zum Einsatz kommt. Diese erreicht einheitliche SRA der resultierenden EKP-Signale über alle untersuchten Zeitskalen hinweg. Die erhaltenen, gemittelten EKP-Wellenformen weisen Morphologien auf, die sowohl mit einschlägigen Literaturwerten als auch mit den im ersten Teil dieses Manuskripts erhaltenen Referenzaufnahmen konsistent sind, wobei alle markanten Wellen deutlich in den Gesamtmittelwerten sichtbar sind. Das neuartige Stimulationsparadigma verkürzt die Erfassungszeit um den Faktor 3.4 und vergrößert gleichzeitig den erreichten SRA erheblich. Die Ergebnisse deuten darauf hin, dass die vorgeschlagene verschachtelte Stimuluspräsentation und die nachgelagerte EKP-Verarbeitungsmethodik zur schnellen, zuverlässigen Extraktion neuronaler Korrelate der gesamten auditorischen Verarbeitung im Rahmen zukünftiger Studien geeignet sind.Bundesministerium für Bildung und Forschung | Bimodal Fusion - Eine neurotechnologische Optimierungsarchitektur für integrierte bimodale Hörsysteme | 2016-201