Somatosensory Cross-Modal Reorganization in Adults With Age-Related, Early-Stage Hearing Loss

Anodal direct current stimulation of the auditory cortex at the onset of presbycusis delays cortical aging

Presbycusis or age-related hearing loss (ARHL) affects millions of people worldwide, increasing their risk of cognitive decline and poor quality of life. However, ARHL remains an irreversible condition due to our inability to induce inner-ear hair cell regeneration. Nevertheless, multisession epidural stimulation of the auditory cortex (AC) at the onset of ARHL prevents hearing threshold elevation in naturally aging Wistar rats. Accordingly, we hypothesized that anodal direct current (DC) stimulation of the AC may also compensate for age-related maladaptive, activity-dependent changes. Here, we examined immunocytochemical markers in the AC, including early genes (c-fos and Arc), AMPA receptors (GluR2/3), parvalbumin (PV), and GAD67, along with auditory-evoked potentials (CAEPs) recorded in both auditory and visual (VC) cortices. When comparing 6 and 18.13-month-old rats without AC simulation, we observed loss of c-fos and Arc-positive neurons and decreased GluR2/3 expression, confirming altered AC neuronal network plasticity and activation. In addition, we noted changes in PV and decreased GAD67 immunoreactivity suggesting disrupted inhibition and significantly increased wave amplitudes in CAEPs, altered AC latencies, and decreased VC responses. By contrast, electrically stimulated rats showed no significant variations in early gene markers, GluR2/3, PV, or GAD67 with age, and the amplitudes and latencies of CAEPs recorded in their AC and VC resembled those of young rat. These findings indicate that anodal DC stimulation at the onset of ARHL delays AC aging by minimizing the loss of inhibition and preventing increases in cortical excitability in Wistar rats.

Hearing loss and the risk of dementia: A longitudinal analysis of the Korean National Health Insurance Service Senior Cohort

BackgroundHearing loss is a potentially modifiable risk factor implicated in dementia, with recent research suggesting an association between age-related hearing degradation and dementia.ObjectiveThis study aims to elucidate the relationship between hearing decline and dementia risk.MethodsWe analyzed data from 511,953 subjects from the Korean National Health Insurance Service-Senior Cohort (2002-2008). After excluding those diagnosed with dementia in 2002, 511,935 subjects were included. Subjects with hearing loss between 2002 and 2008 were selected and matched with a control group without hearing impairment based on age and gender. Statistical analyses, including Pearson's chi-squared test and the Cox proportional hazards model, were conducted, controlling for confounding variables such as household income and residential area. Subgroup analysis was also performed for Alzheimer's disease and vascular dementia.ResultsSubjects with hearing loss had a 1.245 times higher risk of all-cause dementia compared to those without hearing loss (adjusted hazard ratio over 3 years, 95% CI = 1.201-1.290), adjusting for gender, age, residence, and income. The adjusted hazard ratios for Alzheimer's disease over 3, 5, 7, and 10 years from the index date were 1.259 (95% CI = 1.211-1.308), 1.258 (95% CI = 1.208-1.310), 1.269 (95% CI = 1.215-1.325), and 1.235 (95% CI = 1.170-1.304), respectively. No significant association was found for vascular dementia, except for 3 years.ConclusionsHearing loss consistently increased the risk of all-cause dementia and Alzheimer's disease across timespans, suggesting a complex link between hearing loss and neurodegenerative diseases. These findings highlight the importance of early intervention and cognitive monitoring for individuals with hearing loss.

COCHLEA: Longitudinal Cognitive Performance of Older Adults with Hearing Loss and Cochlear Implants at 4.5-Year Follow-Up

OBJECTIVES

Hearing loss is highly prevalent in older adults and is independently associated with accelerated cognitive decline. Cochlear implants are usually the only effective treatment for people with severe-profound hearing loss, who have the highest risk of cognitive decline and dementia, however, very few receive them. Current evidence of the effects of cochlear implant use on cognitive decline/dementia outcomes is limited and unclear. This study aimed to investigate the effect of cochlear implant use on longitudinal cognitive performance, as this intervention may be an effective method of modifying cognitive outcomes for older adults with significant hearing loss.

METHODS

This prospective longitudinal observational study investigated cognitive performance in a convenience sample of older adults (mean age 74 years) with cochlear implants over 4.5 years post-implantation, comparing this with that of community-living adults with untreated hearing loss/normal hearing over 3 years (Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing; AIBL). All participants were assessed at 18-month intervals from baseline using the same measures. Panel regression was used to compare cognitive trajectories.

RESULTS

Cochlear implant users demonstrated significantly improved performance in executive function and working memory, as well as stability in attention, psychomotor function, and visual learning at 4.5-year follow-up. Comparatively, AIBL participants showed significantly greater worsening performance per year in attention and psychomotor function, and stability in working memory and visual learning at 3-year follow-up.

CONCLUSIONS

Cochlear implant use may delay cognitive decline and/or improve cognitive performance in older adults with severe-profound hearing loss, providing proof-of-concept evidence of the positive effects of hearing intervention on cognitive performance in older adults with hearing loss.

Abnormal topological structure of structural covariance networks based on fractal dimension in noise induced hearing loss

The topological attributes of structural covariance networks (SCNs) based on fractal dimension (FD) and changes in brain network connectivity were investigated using graph theory and network-based statistics (NBS) in patients with noise-induced hearing loss (NIHL). High-resolution 3D T1 images of 40 patients with NIHL and 38 healthy controls (HCs) were analyzed. FD-based Pearson correlation coefficients were calculated and converted to Fisher's Z to construct the SCNs. Topological attributes and network hubs were calculated using the graph theory. Topological measures between groups were compared using nonparametric permutation tests. Abnormal connection networks were identified using NBS analysis. The NIHL group showed a significantly increased normalized clustering coefficient, normalized characteristic path length, and decreased nodal efficiency of the right medial orbitofrontal gyrus. Additionally, the network hubs based on betweenness centrality and degree centrality were both the right transverse temporal gyrus and left parahippocampal gyrus in the NIHL group. The NBS analysis revealed two subnetworks with abnormal connections. The subnetwork with enhanced connections was mainly distributed in the default mode, frontoparietal, dorsal attention, and somatomotor networks, whereas the subnetwork with reduced connections was mainly distributed in the limbic, visual, default mode, and auditory networks. These findings demonstrate the abnormal topological structure of FD-based SCNs in patients with NIHL, which may contribute to understand the complex mechanisms of brain damage at the network level, providing a new theoretical basis for neuropathological mechanisms.

Layer-specific enhancement of visual-evoked activity in the audiovisual cortex following a mild degree of hearing loss in adult rats

Following adult-onset hearing impairment, crossmodal plasticity can occur within various sensory cortices, often characterized by increased neural responses to visual stimulation in not only the auditory cortex, but also in the visual and audiovisual cortices. In the present study, we used an established model of loud noise exposure in rats to examine, for the first time, whether the crossmodal plasticity in the audiovisual cortex that occurs following a relatively mild degree of hearing loss emerges solely from altered intracortical processing or if thalamocortical changes also contribute to the crossmodal effects. Using a combination of an established pharmacological 'cortical silencing' protocol and current source density analysis of the laminar activity recorded across the layers of the audiovisual cortex (i.e., the lateral extrastriate visual cortex, V2L), we observed layer-specific changes post-silencing in the strength of the residual visual, but not auditory, input in the noise exposed rats with mild hearing loss compared to rats with normal hearing. Furthermore, based on a comparison of the laminar profiles pre- versus post-silencing in both groups, we can conclude that noise exposure caused a re-allocation of the strength of visual inputs across the layers of the V2L cortex, including enhanced visual-evoked activity in the granular layer; findings consistent with thalamocortical plasticity. Finally, we confirmed that audiovisual integration within the V2L cortex depends on intact processing within intracortical circuits, and that this form of multisensory processing is vulnerable to disruption by noise-induced hearing loss. Ultimately, the present study furthers our understanding of the contribution of intracortical and thalamocortical processing to crossmodal plasticity as well as to audiovisual integration under both normal and mildly-impaired hearing conditions.

Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial

OBJECTIVE

Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment.

STUDY DESIGN

Randomized, controlled, single-site, early phase II, superiority trial.

SETTING

Tertiary academic medical center.

PARTICIPANTS

One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included.

INTERVENTIONS

Participants will be randomized 1:1 to a best practice hearing intervention or a health education control.

MAIN OUTCOME MEASURES

The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity.

RESULTS

Trial enrollment will begin in early 2024.

CONCLUSIONS

After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

Speech Comprehension by Cochlear Implant Users Assessed with Evoked Potentials and Response Times

INTRODUCTION

Cochlear implant (CI) users differ greatly in their rehabilitation outcomes, including speech understanding in noise. This variability may be related to brain changes associated with intact senses recruiting cortical areas from stimulation-deprived senses. Numerous studies have demonstrated such cross-modal reorganization in individuals with untreated hearing loss. How it is affected by regular use of hearing devices remains unclear, however. To shed light on this, the current study measured cortical responses reflecting comprehension abilities in experienced CI users and normal-hearing controls.

METHODS

Using multichannel electroencephalography, we tested CI users who had used their devices for at least 12 months and closely matched controls (N = 2 × 13). Cortical responses reflecting comprehension abilities - the N400 and late positive complex (LPC) components - were evoked using congruent and incongruent digit-triplet stimuli. The participants' task was to assess digit-triplet congruency by means of timed button presses. All measurements were performed in speech-shaped noise 15 dB above individually measured speech recognition thresholds. Three stimulus presentation modes were used: auditory-only, visual-only, and visual-then-auditory.

RESULTS

The analyses revealed no group differences in the N400 and LPC responses. In terms of response times, the CI users were slower and differentially affected by the three stimulus presentation modes relative to the controls.

CONCLUSION

Compared to normal-hearing controls, experienced CI users may need more time to comprehend speech in noise. Response times can serve as a proxy for speech comprehension by CI users.

Sound-localization-related activation and functional connectivity of dorsal auditory pathway in relation to demographic, cognitive, and behavioral characteristics in age-related hearing loss

Background

Patients with age-related hearing loss (ARHL) often struggle with tracking and locating sound sources, but the neural signature associated with these impairments remains unclear.

Materials and methods

Using a passive listening task with stimuli from five different horizontal directions in functional magnetic resonance imaging, we defined functional regions of interest (ROIs) of the auditory "where" pathway based on the data of previous literatures and young normal hearing listeners (n = 20). Then, we investigated associations of the demographic, cognitive, and behavioral features of sound localization with task-based activation and connectivity of the ROIs in ARHL patients (n = 22).

Results

We found that the increased high-level region activation, such as the premotor cortex and inferior parietal lobule, was associated with increased localization accuracy and cognitive function. Moreover, increased connectivity between the left planum temporale and left superior frontal gyrus was associated with increased localization accuracy in ARHL. Increased connectivity between right primary auditory cortex and right middle temporal gyrus, right premotor cortex and left anterior cingulate cortex, and right planum temporale and left lingual gyrus in ARHL was associated with decreased localization accuracy. Among the ARHL patients, the task-dependent brain activation and connectivity of certain ROIs were associated with education, hearing loss duration, and cognitive function.

Conclusion

Consistent with the sensory deprivation hypothesis, in ARHL, sound source identification, which requires advanced processing in the high-level cortex, is impaired, whereas the right-left discrimination, which relies on the primary sensory cortex, is compensated with a tendency to recruit more resources concerning cognition and attention to the auditory sensory cortex. Overall, this study expanded our understanding of the neural mechanisms contributing to sound localization deficits associated with ARHL and may serve as a potential imaging biomarker for investigating and predicting anomalous sound localization.

Somatosensory gating is related to behavioral and verbal outcomes in children with mild-to-severe hearing loss

Sensory gating is a process by which the brain filters out redundant information to preserve neural resources for behaviorally relevant stimuli. Although studies have shown alterations in auditory and visual processing in children who are hard-of-hearing (CHH) relative to children with normal hearing (CNH), it is unclear whether these alterations extend to the somatosensory domain, and how aberrations in sensory processing affect sensory gating. In this study, CHH and CNH were presented with a paired-pulse median nerve stimulation during magnetoencephalography. Stimulus-related gamma neural activity was imaged and virtual time series from peak somatosensory responses were extracted. We found significant effects of both stimulus and group, as well as a significant group-by-stimulus interaction. CHH showed a larger response to stimulation overall, as well as greater differences in gamma power from the first to the second stimulus. However, when looking at the ratio rather than the absolute difference in power, CHH showed comparable gating to CNH. In addition, smaller gating ratios were correlated with better classroom behavior and verbal ability in CHH, but not CNH. Taken together, these data underscore the importance of considering how CHH experience their multisensory environment when interpreting outcomes and designing interventions.

Neurosensory development of the four brainstem-projecting sensory systems and their integration in the telencephalon

Somatosensory, taste, vestibular, and auditory information is first processed in the brainstem. From the brainstem, the respective information is relayed to specific regions within the cortex, where these inputs are further processed and integrated with other sensory systems to provide a comprehensive sensory experience. We provide the organization, genetics, and various neuronal connections of four sensory systems: trigeminal, taste, vestibular, and auditory systems. The development of trigeminal fibers is comparable to many sensory systems, for they project mostly contralaterally from the brainstem or spinal cord to the telencephalon. Taste bud information is primarily projected ipsilaterally through the thalamus to reach the insula. The vestibular fibers develop bilateral connections that eventually reach multiple areas of the cortex to provide a complex map. The auditory fibers project in a tonotopic contour to the auditory cortex. The spatial and tonotopic organization of trigeminal and auditory neuron projections are distinct from the taste and vestibular systems. The individual sensory projections within the cortex provide multi-sensory integration in the telencephalon that depends on context-dependent tertiary connections to integrate other cortical sensory systems across the four modalities.

Considering hearing loss as a modifiable risk factor for dementia

INTRODUCTION

Accumulating evidence links hearing loss to impaired cognitive performance and increased risk for dementia. Hearing loss can lead to deafferentation-induced atrophy of frontotemporal brain regions and dysregulation of cognitive control networks from increased listening effort. Hearing loss is also associated with reduced social engagement, loneliness, and depression, which are independently associated with poor cognitive function.

AREAS COVERED

We summarize the evidence and postulated mechanisms linking hearing loss to dementia in older adults and synthesize the available literature demonstrating beneficial effects of hearing remediation on brain structure and function.

EXPERT OPINION

: Further research is needed to evaluate whether treatment of hearing loss may reduce risk of cognitive decline and improve neural consequences of hearing loss. Studies may investigate the pathologic mechanisms linking these late-life disorders and identify individuals vulnerable to dementia, and future clinical trials may evaluate whether hearing treatment may reduce the risk for dementia.

Cross-Modal Reorganization From Both Visual and Somatosensory Modalities in Cochlear Implanted Children and Its Relationship to Speech Perception

HYPOTHESIS

We hypothesized that children with cochlear implants (CIs) who demonstrate cross-modal reorganization by vision also demonstrate cross-modal reorganization by somatosensation and that these processes are interrelated and impact speech perception.

BACKGROUND

Cross-modal reorganization, which occurs when a deprived sensory modality's cortical resources are recruited by other intact modalities, has been proposed as a source of variability underlying speech perception in deaf children with CIs. Visual and somatosensory cross-modal reorganization of auditory cortex have been documented separately in CI children, but reorganization in these modalities has not been documented within the same subjects. Our goal was to examine the relationship between cross-modal reorganization from both visual and somatosensory modalities within a single group of CI children.

METHODS

We analyzed high-density electroencephalogram responses to visual and somatosensory stimuli and current density reconstruction of brain activity sources. Speech perception in noise testing was performed. Current density reconstruction patterns were analyzed within the entire subject group and across groups of CI children exhibiting good versus poor speech perception.

RESULTS

Positive correlations between visual and somatosensory cross-modal reorganization suggested that neuroplasticity in different sensory systems may be interrelated. Furthermore, CI children with good speech perception did not show recruitment of frontal or auditory cortices during visual processing, unlike CI children with poor speech perception.

CONCLUSION

Our results reflect changes in cortical resource allocation in pediatric CI users. Cross-modal recruitment of auditory and frontal cortices by vision, and cross-modal reorganization of auditory cortex by somatosensation, may underlie variability in speech and language outcomes in CI children.

Changes in cortical auditory evoked potentials in response to auditory training in elderly hearing aid users: A pilot study

OBJECTIVE

To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis.

DESIGN

This is a pilot, prospective, randomized, single-blind study.

STUDY SAMPLE

Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids.

RESULTS

There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared.

CONCLUSION

There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis.

The Laterality of Early Age-Related Hearing Loss and Brain β-Amyloid

OBJECTIVE

Worse hearing was linked to higher brain β-amyloid, a pathologic hallmark of Alzheimer's disease, in a recent study. We analyze the associations between β-amyloid and early age-related hearing loss in the right versus left ear to explore the laterality of this relationship.

STUDY DESIGN

Cross-sectional analysis of a prospective cohort study.

SETTING

Tertiary referral center.

PARTICIPANTS

Ninety-eight late middle-age adults.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The primary outcome was whole brain and regional β-amyloid standardized uptake value ratio (SUVR) on positron emission tomography. The exposure was hearing in the right and left ear, measured by pure tone average (PTA) and word recognition score (WRS). Linear regression analyzed the association between β-amyloid and hearing in each ear, adjusting for potential confounders, including age, gender, education, cardiovascular disease, and hearing aid use.

RESULTS

Mean age ± standard deviation was 64.3 ± 3.5 years. Mean PTA was 20.4 ± 8.8 dB. Multivariable regression adjusting for covariates demonstrated that a 10 dB worsening in PTA in the left ear was associated with significantly higher β-amyloid (SUVR) in the bilateral cingulate gyri (right coefficient: 0.029 [95% confidence interval: 0.003-0.054]; left: 0.029 [0.003-0.055]), bilateral frontal lobes (right: 0.024 [0.002-0.047]; left: 0.028 [0.006-0.049]), and the right temporal lobe (0.019 [0.002-0.037]). Consistent results were observed when WRS served as the exposure. No associations were observed between β-amyloid and PTA or WRS in the right ear.

CONCLUSIONS

Worse hearing in the left ear, but not the right ear, was associated with higher β-amyloid. This might relate to asymmetric central auditory processing.

Altered Functional Network in Infants With Profound Bilateral Congenital Sensorineural Hearing Loss: A Graph Theory Analysis

Functional magnetic resonance imaging (fMRI) studies have suggested that there is a functional reorganization of brain areas in patients with sensorineural hearing loss (SNHL). Recently, graph theory analysis has brought a new understanding of the functional connectome and topological features in central neural system diseases. However, little is known about the functional network topology changes in SNHL patients, especially in infants. In this study, 34 infants with profound bilateral congenital SNHL and 28 infants with normal hearing aged 11–36 months were recruited. No difference was found in small-world parameters and network efficiency parameters. Differences in global and nodal topologic organization, hub distribution, and whole-brain functional connectivity were explored using graph theory analysis. Both normal-hearing infants and SNHL infants exhibited small-world topology. Furthermore, the SNHL group showed a decreased nodal degree in the bilateral thalamus. Six hubs in the SNHL group and seven hubs in the normal-hearing group were identified. The left middle temporal gyrus was a hub only in the SNHL group, while the right parahippocampal gyrus and bilateral temporal pole were hubs only in the normal-hearing group. Functional connectivity between auditory regions and motor regions, between auditory regions and default-mode-network (DMN) regions, and within DMN regions was found to be decreased in the SNHL group. These results indicate a functional reorganization of brain functional networks as a result of hearing loss. This study provides evidence that functional reorganization occurs in the early stage of life in infants with profound bilateral congenital SNHL from the perspective of complex networks.

Dual-Task Performance in Hearing-Impaired Older Adults-Study Protocol for a Cross-Sectional Mobile Brain/Body Imaging Study

Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments.

Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50–70 years) and 48 younger adults (20–30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes.

Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.

Hearing impairment and missing cognitive test scores in a population-based study of older adults: The Atherosclerosis Risk in Communities neurocognitive study

INTRODUCTION

Hearing impairment is associated with poor cognitive test performance in older adults. However, hearing's impact on cognitive test completion is poorly described, and missing cognitive data due to hearing impairment could misestimate the association.

METHODS

We investigated if hearing impairment is associated with missing neurocognitive scores in 3678 adults (72-94 years). Hearing impairment was defined by the better-ear pure tone average of speech-frequency thresholds (0.5-4 kHz) >25 decibels.

RESULTS

Hearing impairment was associated with greater missingness on all auditory-only tests, including Logical Memory (prevalence ratio [PR] comparing ≥ moderate impairment vs normal hearing:1.68, 95% confidence interval [CI] 1.26, 2.25) and Digits Backwards (PR 1.62; 95% CI 1.21, 2.17); and two non-auditory tests, Boston Naming (PR 1.61; 95% CI 1.21, 2.17) and Trail Making B (PR 1.55; 95% CI 1.29, 1.86). Models that imputed missing cognitive scores showed the strongest hearing-cognition associations.

DISCUSSION

Older adults with hearing impairment are less likely to complete cognitive testing, thereby underestimating the hearing impairment-cognition relationship.

[Hearing care aspects in universal face mask use during the COVID 19 pandemic]

BACKGROUND

Typical cloth and medical masks, which are mandatory to wear during the COVID 19 pandemic, create visual barrier, obscure linguistic and nonverbal communication and interaction. Ski-slope hearing loss patients often don't admit their auditory insufficiency and do not use hearing aids due to acceptable speech intelligibility by using visual access to the mouth and other potential facial cues.

PURPOSE

To assess the impact of universal face medical masks in public places on motivation to using hearing aids of patients with ski-slope hearing loss.

PATIENTS AND METHODS

All the 504 patients (18-65 years old), who applied for < hearing care assistance and for the first time bought hearing aid were included. 266 patients (group A) applied from June to November 2020, when wearing facial masks was mandatory; 238 patients (group B) applied from June to November 2019, when wearing facial masks wasn't required. In both groups patients, who fulfilled the following criteria, were selected: 1) binaural mild to severe sensorineural ski-slope hearing loss lasting more than 3 years; 2) no progression of hearing loss within the last 3 years; 3) pure tone audiometry <20 dB HL at 125-1000 Hz frequencies; 4) hearing care with mono- or binaural hearing aids with the receiver-in-the-canal open-type. Questionnaires were administered to eligible patients in group A to assess the motivational components of acquiring hearing aids.

RESULTS AND DISCUSSION

In group A, 74 (28%) patients received hearing aids according to the inclusion criteria, and in group B, 46 (19%) patients received hearing aids (p=0.033). Significant factors determining hearing aid acquisition were lack of visual contact when wearing a mask, communication difficulties in noisy environments and lack of intelligibility in a concert hall or lecture.

CONCLUSION

Patients' motivation to hearing care grows in mandatory wearing facial masks conditions during the COVID-19 pandemic leading to an increase in patients using hearing aids.

Screening Tools and Assessment Methods of Cognitive Decline Associated With Age-Related Hearing Loss: A Review

Strong links between hearing and cognitive function have been confirmed by a growing number of cross-sectional and longitudinal studies. Seniors with age-related hearing loss (ARHL) have a significantly higher cognitive impairment incidence than those with normal hearing. The correlation mechanism between ARHL and cognitive decline is not fully elucidated to date. However, auditory intervention for patients with ARHL may reduce the risk of cognitive decline, as early cognitive screening may improve related treatment strategies. Currently, clinical audiology examinations rarely include cognitive screening tests, partly due to the lack of objective quantitative indicators with high sensitivity and specificity. Questionnaires are currently widely used as a cognitive screening tool, but the subject's performance may be negatively affected by hearing loss. Numerous electroencephalogram (EEG) and magnetic resonance imaging (MRI) studies analyzed brain structure and function changes in patients with ARHL. These objective electrophysiological tools can be employed to reveal the association mechanism between auditory and cognitive functions, which may also find biological markers to be more extensively applied in assessing the progression towards cognitive decline and observing the effects of rehabilitation training for patients with ARHL. In this study, we reviewed clinical manifestations, pathological changes, and causes of ARHL and discussed their cognitive function effects. Specifically, we focused on current cognitive screening tools and assessment methods and analyzed their limitations and potential integration.

Age-related hearing loss and cognitive decline: MRI and cellular evidence

Extensive evidence supports the association between age-related hearing loss (ARHL) and cognitive decline. It is, however, unknown whether a causal relationship exists between these two, or whether they both result from shared mechanisms. This paper intends to study this relationship through a comprehensive review of MRI findings as well as evidence of cellular alterations. Our review of structural MRI studies demonstrates that ARHL is independently linked to accelerated atrophy of total and regional brain volumes and reduced white matter integrity. Resting-state and task-based fMRI studies on ARHL also show changes in spontaneous neural activity and brain functional connectivity; and alterations in brain areas supporting auditory, language, cognitive, and affective processing independent of age, respectively. Although MRI findings support a causal relationship between ARHL and cognitive decline, the contribution of potential shared mechanisms should also be considered. In this regard, the review of cellular evidence indicates their role as possible common mechanisms underlying both age-related changes in hearing and cognition. Considering existing evidence, no single hypothesis can explain the link between ARHL and cognitive decline, and the contribution of both causal (i.e., the sensory hypothesis) and shared (i.e., the common cause hypothesis) mechanisms is expected.

Altered resting-state functional network connectivity in profound sensorineural hearing loss infants within an early sensitive period: A group ICA study

Data from both animal models and deaf children provide evidence for that the maturation of auditory cortex has a sensitive period during the first 2-4 years of life. During this period, the auditory stimulation can affect the development of cortical function to the greatest extent. Thus far, little is known about the brain development trajectory after early auditory deprivation within this period. In this study, independent component analysis (ICA) technique was used to detect the characteristics of brain network development in children with bilateral profound sensorineural hearing loss (SNHL) before 3 years old. Seven resting-state networks (RSN) were identified in 50 SNHL and 36 healthy controls using ICA method, and further their intra-and inter-network functional connectivity (FC) were compared between two groups. Compared with the control group, SNHL group showed decreased FC within default mode network, while enhanced FC within auditory network (AUN) and salience network. No significant changes in FC were found in the visual network (VN) and sensorimotor network (SMN). Furthermore, the inter-network FC between SMN and AUN, frontal network and AUN, SMN and VN, frontal network and VN were significantly increased in SNHL group. The results implicate that the loss and the compensatory reorganization of brain network FC coexist in SNHL infants. It provides a network basis for understanding the brain development trajectory after hearing loss within early sensitive period.

Quantitative EEG measures in profoundly deaf and normal hearing individuals while performing a vibrotactile temporal discrimination task

Challenges in early oral language acquisition in profoundly deaf individuals have an impact on cognitive neurodevelopment. This has led to the exploration of alternative sound perception methods involving training of vibrotactile discrimination of sounds within the language spectrum. In particular, stimulus duration plays an important role in linguistic categorical perception. We comparatively evaluated vibrotactile temporal discrimination of sound and how specific training can modify the underlying electrical brain activity. Fifteen profoundly deaf (PD) and 15 normal-hearing (NH) subjects performed a vibrotactile oddball task with simultaneous EEG recording, before and after a short training period (5 one-hour sessions; in 2.5-3 weeks). The stimuli consisted of 700 Hz pure-tones with different duration (target: long 500 ms; non-target: short 250 ms). The sound-wave stimuli were delivered by a small device worn on the right index finger. A similar behavioral training effect was observed in both groups showing significant improvement in sound-duration discrimination. However, quantitative EEG measurements reveal distinct neurophysiological patterns characterized by higher and more diffuse delta band magnitudes in the PD group, together with a generalized decrement in absolute power in both groups that might reflect a facilitating process associated to learning. Furthermore, training-related changes were found in the beta-band in NH. Findings suggest PD have different cognitive adaptive mechanisms which are not a mere amplification effect due to greater cortical excitability.

Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults

Substantial evidence now links age-related hearing loss to incident major depressive disorder in older adults. However, research examining the neural circuits and behavioral mechanisms by which age-related hearing loss leads to depression is at an early phase. It is known that hearing loss has adverse structural and functional brain consequences, is associated with reduced social engagement and loneliness, and often results in tinnitus, which can independently affect cognitive control and emotion processing circuits. While pathways leading from these sequelae of hearing loss to affective dysregulation and depression are intuitive to hypothesize, few studies have yet been designed to provide conclusive evidence for specific pathophysiological mechanisms. Here we review the neurobiological and behavioral consequences of age-related hearing loss, present a model linking them to increased risk for major depressive disorder and suggest how future studies may facilitate the development of rationally designed therapeutic interventions for older adults with impaired hearing to reduce risk for depression and/or ameliorate depressive symptoms.

Posterior parietal cortex contributions to cross-modal brain plasticity upon sensory loss

Sensory loss causes compensatory behavior, like echolocation upon vision loss or improved visual motion detection upon deafness. This is enabled by recruitment of the deprived cortical area by the intact senses. Such cross-modal plasticity can however hamper rehabilitation via sensory substitution devices. To steer rehabilitation towards the desired outcome for the patient, having control over the cross-modal take-over is essential. Evidence accumulates to support a role for the posterior parietal cortex (PPC) in multimodal plasticity. This area shows increased activity after sensory loss, keeping similar functions but driven by other senses. Patient-specific factors like stress, social situation, age and attention, have a significant influence on the PPC and on cross-modal plasticity. We propose that understanding the response of the PPC to sensory loss and context is extremely important for determining the best possible implant-based therapies, and that mouse research holds potential to help unraveling the underlying anatomical, cellular and neuromodulatory mechanisms.

Effects of longstanding degraded auditory signal on visuospatial, visuomotor, and visual attention skills in adults with hearing loss

OBJECTIVE

This study examined the consequences of long-term auditory deprivation on visuospatial functions, visuomotor functions, and visual attention skills in adults with early-onset hearing loss.

METHODS

Fifteen adults with bilateral, early-onset (before age 3), severe-to-profound hearing loss who used spoken language participated in this study. Visuospatial (figure ground, form constancy, visual perception) and visuomotor functions (visuomotor integration, visual search) were examined using norm-referenced tests. Visual attention scales were examined using a computerized program, IVA plus continuous performance test.

RESULTS

As a group, participants performed in the average range on visuospatial and visuomotor functions when compared to normative data presented in the test instruments. However, participants demonstrated below average performance on sustained visual attention. Duration of cochlear implant use positively correlated with one of the visual attention scales, namely visual speed.

CONCLUSIONS

The findings of the current study suggest that adults with early-onset hearing loss may demonstrate difficulties in sustaining attention to visual information. Data also suggest that increased experience with cochlear implant may ameliorate deficits associated with visual attention. Future studies should explore challenges experienced by adults with early-onset hearing loss in their daily activities that may result from this deficit and intervention programs that may enhance visual attention skills.

Cortical Neuroplasticity and Cognitive Function in Early-Stage, Mild-Moderate Hearing Loss: Evidence of Neurocognitive Benefit From Hearing Aid Use

Age-related hearing loss (ARHL) is associated with cognitive decline as well as structural and functional brain changes. However, the mechanisms underlying neurocognitive deficits in ARHL are poorly understood and it is unclear whether clinical treatment with hearing aids may modify neurocognitive outcomes. To address these topics, cortical visual evoked potentials (CVEPs), cognitive function, and speech perception abilities were measured in 28 adults with untreated, mild-moderate ARHL and 13 age-matched normal hearing (NH) controls. The group of adults with ARHL were then fit with bilateral hearing aids and re-evaluated after 6 months of amplification use. At baseline, the ARHL group exhibited more extensive recruitment of auditory, frontal, and pre-frontal cortices during a visual motion processing task, providing evidence of cross-modal re-organization and compensatory cortical neuroplasticity. Further, more extensive cross-modal recruitment of the right auditory cortex was associated with greater degree of hearing loss, poorer speech perception in noise, and worse cognitive function. Following clinical treatment with hearing aids, a reversal in cross-modal re-organization of auditory cortex by vision was observed in the ARHL group, coinciding with gains in speech perception and cognitive performance. Thus, beyond the known benefits of hearing aid use on communication, outcomes from this study provide evidence that clinical intervention with well-fit amplification may promote more typical cortical organization and functioning and provide cognitive benefit.

Somatosensory Cross-Modal Reorganization in Children With Cochlear Implants

Deprived of sensory input, as in deafness, the brain tends to reorganize. Cross-modal reorganization occurs when cortices associated with deficient sensory modalities are recruited by other, intact senses for processing of the latter's sensory input. Studies have shown that this type of reorganization may affect outcomes when sensory stimulation is later introduced via intervention devices. One such device is the cochlear implant (CI). Hundreds of thousands of CIs have been fitted on people with hearing impairment worldwide, many of them children. Factors such as age of implantation have proven useful in predicting speech perception outcome with these devices in children. However, a portion of the variance in speech understanding ability remains unexplained. It is possible that the degree of cross-modal reorganization may explain additional variability in listening outcomes. Thus, the current study aimed to examine possible somatosensory cross-modal reorganization of the auditory cortices. To this end we used high density EEG to record cortical responses to vibrotactile stimuli in children with normal hearing (NH) and those with CIs. We first investigated cortical somatosensory evoked potentials (CSEP) in NH children, in order to establish normal patterns of CSEP waveform morphology and sources of cortical activity. We then compared CSEP waveforms and estimations of cortical sources between NH children and those with CIs to assess the degree of somatosensory cross-modal reorganization. Results showed that NH children showed expected patterns of CSEP and current density reconstructions, such that postcentral cortices were activated contralaterally to the side of stimulation. Participants with CIs also showed this pattern of activity. However, in addition, they showed activation of auditory cortical areas in response to somatosensory stimulation. Additionally, certain CSEP waveform components were significantly earlier in the CI group than the children with NH. These results are taken as evidence of cross-modal reorganization by the somatosensory modality in children with CIs. Speech perception in noise scores were negatively associated with CSEP waveform components latencies in the CI group, suggesting that the degree of cross-modal reorganization is related to speech perception outcomes. These findings may have implications for clinical rehabilitation in children with cochlear implants.

Compensatory Plasticity in the Lateral Extrastriate Visual Cortex Preserves Audiovisual Temporal Processing following Adult-Onset Hearing Loss

Partial hearing loss can cause neurons in the auditory and audiovisual cortices to increase their responsiveness to visual stimuli; however, behavioral studies in hearing-impaired humans and rats have found that the perceptual ability to accurately judge the relative timing of auditory and visual stimuli is largely unaffected. To investigate the neurophysiological basis of how audiovisual temporal acuity may be preserved in the presence of hearing loss-induced crossmodal plasticity, we exposed adult rats to loud noise and two weeks later performed in vivo electrophysiological recordings in two neighboring regions within the lateral extrastriate visual (V2L) cortex—a multisensory zone known to be responsive to audiovisual stimuli (V2L-Mz) and a predominantly auditory zone (V2L-Az). To examine the cortical layer-specific effects at the level of postsynaptic potentials, a current source density (CSD) analysis was applied to the local field potential (LFP) data recorded in response to auditory and visual stimuli presented at various stimulus onset asynchronies (SOAs). As predicted, differential effects were observed in the neighboring cortical regions' postnoise exposure. Most notably, an analysis of the strength of multisensory response interactions revealed that V2L-Mz lost its sensitivity to the relative timing of the auditory and visual stimuli, due to an increased responsiveness to visual stimulation that produced a prominent audiovisual response irrespective of the SOA. In contrast, not only did the V2L-Az in noise-exposed rats become more responsive to visual stimuli but neurons in this region also inherited the capacity to process audiovisual stimuli with the temporal precision and specificity that was previously restricted to the V2L-Mz. Thus, the present study provides the first demonstration that audiovisual temporal processing can be preserved following moderate hearing loss via compensatory plasticity in the higher-order sensory cortices that is ultimately characterized by a functional transition in the cortical region capable of temporal sensitivity.

Hearing-impaired listeners show increased audiovisual benefit when listening to speech in noise

Recent studies provide evidence for changes in audiovisual perception as well as for adaptive cross-modal auditory cortex plasticity in older individuals with high-frequency hearing impairments (presbycusis). We here investigated whether these changes facilitate the use of visual information, leading to an increased audiovisual benefit of hearing-impaired individuals when listening to speech in noise. We used a naturalistic design in which older participants with a varying degree of high-frequency hearing loss attended to running auditory or audiovisual speech in noise and detected rare target words. Passages containing only visual speech served as a control condition. Simultaneously acquired scalp electroencephalography (EEG) data were used to study cortical speech tracking. Target word detection accuracy was significantly increased in the audiovisual as compared to the auditory listening condition. The degree of this audiovisual enhancement was positively related to individual high-frequency hearing loss and subjectively reported listening effort in challenging daily life situations, which served as a subjective marker of hearing problems. On the neural level, the early cortical tracking of the speech envelope was enhanced in the audiovisual condition. Similar to the behavioral findings, individual differences in the magnitude of the enhancement were positively associated with listening effort ratings. Our results therefore suggest that hearing-impaired older individuals make increased use of congruent visual information to compensate for the degraded auditory input.

Prefrontal-Temporal Pathway Mediates the Cross-Modal and Cognitive Reorganization in Sensorineural Hearing Loss With or Without Tinnitus: A Multimodal MRI Study

Objective: Hearing loss, one main risk factor of tinnitus and hyperacusis, is believed to involve significant central functional abnormalities. The recruitment of the auditory cortex in non-auditory sensory and higher-order cognitive processing has been demonstrated in the hearing-deprived brain. The dorsolateral prefrontal cortex (dlPFC), which has dense anatomical connections with the auditory pathway, is known to play a crucial role in multi-sensory integration, auditory regulation, and cognitive processing. This study aimed to verify the role of the dlPFC in the cross-modal reorganization and cognitive participation of the auditory cortex in long-term sensorineural hearing loss (SNHL) by combining functional and structural measurements.

Methods: Thirty five patients with long-term bilateral SNHL and 35 matched healthy controls underwent structural imaging, resting-state functional magnetic resonance imaging (rs-fMRI), diffusion tensor imaging (DTI), and neuropsychological assessments. Ten SNHL patients were with subjective tinnitus.

Results: No differences in gray matter volume, spontaneous neural activity, or diffusion characteristics in the dlPFC were found between the SNHL and control groups. The functional connectivity (FC) between the dlPFC and the auditory cortex and visual areas, such as the cuneus, fusiform, lingual cortex, and calcarine sulcus was increased in patients with SNHL. ANOVA and post hoc tests revealed similar FC alterations in the SNHL patients with and without tinnitus when compared with the normal hearing controls, and SNHL patients with and without tinnitus showed no difference in the dlPFC FC. The FC in the auditory cortex was associated with the symbol digit modality test (SDMT) scores in the SNHL patients, which reflect attentional function, processing speed, and visual working memory. Hearing-related FC with the dlPFC was found in the lingual cortex. A tract-based spatial statistics (TBSS) analysis revealed decreased fractional anisotropy (FA) values, mainly in the temporal inferior fronto-occipital fasciculus (IFOF), which showed remarkable negative correlations with the mean hearing thresholds in SNHL.

Conclusion: Higher functional coupling between the dlPFC and auditory and visual areas, accompanied by decreased FA along the IFOF connecting the frontal cortex and the occipito-temporal area, might mediate cross-modal plasticity via top-down regulation and facilitate the involvement of the auditory cortex in higher-order cognitive processing following long-term SNHL.

Dysconnectivity of Multiple Resting-State Networks Associated With Higher-Order Functions in Sensorineural Hearing Loss

Objects: Sensorineural hearing loss (SNHL) involves wide-ranging functional reorganization, and is associated with accumulating risk of cognitive and emotional dysfunction. The coordination of multiple functional networks supports normal brain functions. Here, we aimed to evaluate the functional connectivity (FC) patterns involving multiple resting-state networks (RSNs), and the correlations between the functional remodeling of RSNs and the potential cognitive or emotional impairments in SNHL.

Methods: Thirty long-term bilateral SNHL patients and 39 well-matched healthy controls were recruited for assessment of resting-state functional magnetic resonance imaging and neuropsychological tests.

Results: Using independent component analysis, 11 RSNs were identified. Relative to the healthy controls, patients with SNHL presented apparent abnormalities of intra-network FC involving right frontoparietal network, posterior temporal network, and sensory motor network. Disrupted between-network FC was also revealed in the SNHL patients across both higher-order cognitive control networks and multiple sensory networks. Eight of the eleven RSNs showed altered functional synchronization using a seed network to whole brain FC method, particularly in the ventromedial prefrontal cortex. In addition, these functional abnormalities were correlated with cognition- and emotion-related performances.

Interpretations: These findings supported our hypotheses that long-term SNHL involves notable dysconnectivity of multiple RSNs. Our study provides important insights into the pathophysiological mechanisms of SNHL, and sheds lights on the neural substrates underlying the possible cognitive and emotional dysfunctions following SNHL.

Neural Correlates of Sensory Abnormalities Across Developmental Disabilities

Abnormalities in sensory processing are a common feature of many developmental disabilities (DDs). Sensory dysfunction can contribute to deficits in brain maturation, as well as many vital functions. Unfortunately, while some patients with DD benefit from the currently available treatments for sensory dysfunction, many do not. Deficiencies in clinical practice surrounding sensory dysfunction may be related to lack of understanding of the neural mechanisms that underlie sensory abnormalities. Evidence of overlap in sensory symptoms between diagnoses suggests that there may be common neural mechanisms that mediate many aspects of sensory dysfunction. Thus, the current manuscript aims to review the extant literature regarding the neural correlates of sensory dysfunction across DD in order to identify patterns of abnormality that span diagnostic categories. Such anomalies in brain structure, function, and connectivity may eventually serve as targets for treatment.