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Pre-attentive cortical evoked potentials reflect training-induced changes in neural activity associated with speech-sound training. Seven normal-hearing young adults were trained to identify two synthetic speech variants of the syllable /ba/. As subjects learned to correctly identify the two stimuli, changes in P1, N1, and P2 amplitudes were observed. Of particular interest is that P1, N1, and P2 components of the N1-P2 complex responded differently to listening training. That is, significant changes in P1 and N1 amplitude were recorded over the right but not the left hemisphere. In contrast, increases in P2 were observed bilaterally. These results indicate that training-related changes in neural activity are reflected in far-field aggregate neural responses and that distinct patterns of neural change, perhaps reflecting hemispheric specialization, likely represent different aspects of auditory function. KEY WORDS: auditory training, auditory plasticity, auditory perceptual learning, N1-P2 complex and MMN, event-related potentials, Auditory training alters neural activity in the human central auditory system. Previous experiments have shown that training-induced neural plasticity can be observed using far-field potentials (Kraus et al., 1995; Naatanen [...]

Objective: A high prevalence of hearing loss in older adults contrasts with a small proportion of people who seek help. Emerging developments in hearing healthcare (HHC) could reduce costs but may not increase access. This study evaluated older adults' perceptions of current and future HHC services in Australia, England, US and Canada to explore potential levers and system improvements. Methods: Semi-structured focus groups (n = 47) were conducted, and data were analysed using a directed content analysis. Participants were adults 60 years and older with a) no hearing problems; b) hearing problems and hearing aid use; and c) hearing problems and no hearing aid use. Results: Perceived barriers, facilitators and preferences were largely consistent across countries, with stigma and trust in HHC being the barriers most often discussed. Conclusion: Although cost and access were consistently deemed important, there may be limited change in help-seeking and HHC uptake unless the key barriers of trust and stigma are addressed. When seeking to undertake transformative change to healthcare it is important to engage recipients of care to understand existing barriers and coproduce a user-centered solution. [ABSTRACT FROM AUTHOR]

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear. Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of “hearing health,” how to achieve it, and implications for policy and practice. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated (a) the effect of amplification on cortical auditory evoked potentials (CAEPs) at different signal levels when signal-to-noise ratios (SNRs) were equated between unaided and aided conditions, and (b) the effect of absolute signal level on aided CAEPs when SNR was held constant. Method: CAEPs were recorded from 13 young adults with normal hearing. A 1000-Hz pure tone was presented in unaided and aided conditions with a linear analog hearing aid. Direct audio input was used, allowing recorded hearing aid noise floor to be added to unaided conditions to equate SNRs between conditions. An additional stimulus was created through scaling the noise floor to study the effect of signal level. Results: Amplification resulted in delayed N1 and P2 peak latencies relative to the unaided condition. An effect of absolute signal level (when SNR was constant) was present for aided CAEP area measures, such that larger area measures were found at higher levels. Conclusion: Results of this study further demonstrate that factors in addition to SNR must also be considered before CAEPs can be used to clinically to measure aided thresholds. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to review recent research from our laboratory on the topic of aging, and the ear-brain system, as it relates to hearing aid use and auditory rehabilitation. The material described here was presented as part of the forum on the brain and hearing aids, at the 2014 HEaling Across the Lifespan (HEAL) conference. Method: The method involves a narrative review of previously reported electroencephalography (EEG) and magnetoencephalography (MEG) data from our laboratory as they relate to the (a) neural detection of amplified sound and (b) ability to learn new sound contrasts. Conclusions: Results from our studies add to the mounting evidence that there are central effects of biological aging as well as peripheral pathology that affect a person's neural detection and use of sound. What is more, these biological effects can be seen as early as middle age. The accruing evidence has implications for hearing aid use because effective communication relies not only on sufficient detection of sound but also on the individual's ability to learn to make use of these sounds in ever-changing listening environments. [ABSTRACT FROM AUTHOR]

Even though auditory training exercises for humans have been shown to improve certain perceptual skills of individuals with and without hearing loss, there is a lack of knowledge pertaining to which aspects of training are responsible for the perceptual gains, and which aspects of perception are changed. To better define how auditory training impacts brain and behavior, electroencephalography (EEG) and magnetoencephalography (MEG) have been used to determine the time course and coincidence of cortical modulations associated with different types of training. Here we focus on P1-N1-P2 auditory evoked responses (AEP), as there are consistent reports of gains in P2 amplitude following various types of auditory training experiences; including music and speech-sound training. The purpose of this experiment was to determine if the auditory evoked P2 response is a biomarker of learning. To do this, we taught native English speakers to identify a new pre-voiced temporal cue that is not used phonemically in the English language so that coinciding changes in evoked neural activity could be characterized. To differentiate possible effects of repeated stimulus exposure and a button-pushing task from learning itself, we examined modulations in brain activity in a group of participants who learned to identify the pre-voicing contrast and compared it to participants, matched in time, and stimulus exposure, that did not. The main finding was that the amplitude of the P2 auditory evoked response increased across repeated EEG sessions for all groups, regardless of any change in perceptual performance. What's more, these effects are retained for months. Changes in P2 amplitude were attributed to changes in neural activity associated with the acquisition process and not the learned outcome itself. A further finding was the expression of a late negativity (LN) wave 600-900 ms post-stimulus onset, post-training exclusively for the group that learned to identify the pre-voiced contrast. [ABSTRACT FROM AUTHOR]

Background Auditory perceptual learning persistently modifies neural networks in the central nervous system. Central auditory processing comprises a hierarchy of sound analysis and integration, which transforms an acoustical signal into a meaningful object for perception. Based on latencies and source locations of auditory evoked responses, we investigated which stage of central processing undergoes neuroplastic changes when gaining auditory experience during passive listening and active perceptual training. Young healthy volunteers participated in a five-day training program to identify two pre-voiced versions of the stop-consonant syllable 'ba', which is an unusual speech sound to English listeners. Magnetoencephalographic (MEG) brain responses were recorded during two pre-training and one post-training sessions. Underlying cortical sources were localized, and the temporal dynamics of auditory evoked responses were analyzed. Results After both passive listening and active training, the amplitude of the P2m wave with latency of 200 ms increased considerably. By this latency, the integration of stimulus features into an auditory object for further conscious perception is considered to be complete. Therefore the P2m changes were discussed in the light of auditory object representation. Moreover, P2m sources were localized in anterior auditory association cortex, which is part of the anteroventral pathway for object identification. The amplitude of the earlier N1m wave, which is related to processing of sensory information, did not change over the time course of the study. Conclusion The P2m amplitude increase and its persistence over time constitute a neuroplastic change. The P2m gain likely reflects enhanced object representation after stimulus experience and training, which enables listeners to improve their ability for scrutinizing fine differences in pre-voicing time. Different trajectories of brain and behaviour changes suggest that the preceding effect of a P2m increase relates to brain processes, which are necessary precursors of perceptual learning. Cautious discussion is required when interpreting the finding of a P2 amplitude increase between recordings before and after training and learning. [ABSTRACT FROM AUTHOR]

Abstract Objective: There is interest in using cortical auditory evoked potentials (CAEPs) to evaluate hearing aid fittings and experience-related plasticity associated with amplification; however, little is known about hearing aid signal processing effects on these responses. The purpose of this study was to determine the effect of clinically relevant hearing aid gain settings, and the resulting in-the-canal signal-to-noise ratios (SNRs), on the latency and amplitude of P1, N1, and P2 waves. Design & Sample: Evoked potentials and in-the-canal acoustic measures were recorded in nine normal-hearing adults in unaided and aided conditions. In the aided condition, a 40-dB signal was delivered to a hearing aid programmed to provide four levels of gain (0, 10, 20, and 30 dB). As a control, unaided stimulus levels were matched to aided condition outputs (i.e. 40, 50, 60, and 70 dB) for comparison purposes. Results: When signal levels are defined in terms of output level, aided CAEPs were surprisingly smaller and delayed relative to unaided CAEPs, probably resulting from increases to noise levels caused by the hearing aid. Discussion: These results reinforce the notion that hearing aids modify stimulus characteristics such as SNR, which in turn affects the CAEP in a way that does not reliably reflect hearing aid gain. Sumario Objetivo: Existe interéés en el uso de los potenciales evocados auditivos corticales (CAEP) para evaluar la adaptacióón de auxiliares auditivos y la plasticidad relacionada con la experiencia, asociada a la amplificacióón; no obstante, se sabe poco sobre los efectos del procesamiento de las seññales de los auxiliares auditivos sobre esas respuestas. El propóósito de esta investigacióón fue determinar el efecto clíínicamente relevante de los ajustes de ganancia de auxiliares auditivos y las relaciones seññal/ruido (SNR) resultantes en el conducto auditivo, sobre la latencia y la amplitud de las ondas P1, N1 y P2. Diseñño y muestra: Se registraron en nueve adultos normoyentes los potenciales evocados y las mediciones acúústicas en el conducto auditivo externo en condiciones de amplificacióón o sin ella. En la primera condicion, se envióó una seññal de 40-dB al auxiliar auditivo programado para proveer cuatro niveles de ganancia (0, 10, 20 y 30 dB). Como control, se parearon niveles de estíímulos sin amplificacióón con las salidas de los estíímulos amplificados (p.ej., 40, 50, 60 y 70 dB) para efectos comparativos. Resultados: Cuando los niveles de la seññal estáán definidos en téérminos de niveles de salida, los CAEP con amplificacióón fueron sorprendentemente menores y tardííos que los CAEP sin amplificacióón, probablemente como resultado de los incrementos en los niveles de ruido, causados por el auxiliar auditivo. Discusion: Estos resultados refuerzan la idea de que los auxiliares auditivos modifican las caracteríísticas de los estíímulos como la SNR, la cual a su vez afecta los CAEP en una forma que no refleja confiablemente la ganancia del auxiliar auditivo. [ABSTRACT FROM AUTHOR]

Performance improvement during an hour of auditory perceptual training is accompanied by rapid physiological changes. These changes may reflect learning or simply task repetition independent of learning. We assessed the contribution of learning and task repetition to changes in auditory evoked potentials during a difficult speech identification task and an easy tone identification task. We posited that only task repetition effects would occur in the tone task but that task repetition and learning would interact in the speech task. Speech identification improved with practice (increased sensitivity d′ with a constant response bias β). This behavioral improvement coincided with a decrease in the amplitude of sensory evoked responses (N1, P2) and a decrease in the amplitude of a slow wave (peak=320 ms after onset) over the left frontal and parietal sites. Results show rapid physiological changes associated with learning, distinct from changes related to task repetition. [ABSTRACT FROM AUTHOR]

Auditory training programs are being developed to remediate various types of communication disorders. Biological changes have been shown to coincide with improved perception following auditory training so there is interest in determining if these changes represent biologic markers of auditory learning. Here we examine the role of stimulus exposure and listening tasks, in the absence of training, on the modulation of evoked brain activity. Twenty adults were divided into two groups and exposed to two similar sounding speech syllables during four electrophysiological recording sessions (24 hours, one week, and up to one year later). In between each session, members of one group were asked to identify each stimulus. Both groups showed enhanced neural activity from session-to-session, in the same P2 latency range previously identified as being responsive to auditory training. The enhancement effect was most pronounced over temporal-occipital scalp regions and largest for the group who participated in the identification task. The effects were rapid and long-lasting with enhanced synchronous activity persisting months after the last auditory experience. Physiological changes did not coincide with perceptual changes so results are interpreted to mean stimulus exposure, with and without being paired with an identification task, alters the way sound is processed in the brain. The cumulative effect likely involves auditory memory; however, in the absence of training, the observed physiological changes are insufficient to result in changes in learned behavior. [ABSTRACT FROM AUTHOR]

Hearing aid amplification can be used as a model for studying the effects of auditory stimulation on the central auditory system (CAS). We examined the effects of stimulus presentation level on the physiological detection of sound in unaided and aided conditions. P1, N1, P2, and N2 cortical evoked potentials were recorded in sound field from 13 normal-hearing young adults in response to a 1000-Hz tone presented at seven stimulus intensity levels. As expected, peak amplitudes increased and peak latencies decreased with increasing intensity for unaided and aided conditions. However, there was no significant effect of amplification on latencies or amplitudes. Taken together, these results demonstrate that 20 dB of hearing aid gain affects neural responses differently than 20 dB of stimulus intensity change. Hearing aid signal processing is discussed as a possible contributor to these results. This study demonstrates (1) the importance of controlling for stimulus intensity when evoking responses in aided conditions, and (2) the need to better understand the interaction between the hearing aid and the CAS. [ABSTRACT FROM AUTHOR]

Auditory evoked cortical responses to changes in the interaural phase difference (IPD) were recorded using magnetoencephalography (MEG). Twelve normal-hearing young adults were tested with amplitude-modulated tones with carrier frequencies of 500, 1000, 1250, and 1500 Hz. The onset of the stimuli evoked P1m-N1m-P2m cortical responses, as did the changes in the interaural phase. Significant responses to IPD changes were identified at 500 and 1000 Hz in all subjects and at 1250 Hz in nine subjects, whereas responses were absent in all subjects at 1500 Hz, indicating a group mean threshold for detecting IPDs of 1250 Hz. Behavioral thresholds were found at 1200 Hz using an adaptive two alternative forced choice procedure. Because the physiological responses require phase information, through synchronous bilateral inputs at the level of the auditory brainstem, physiological “change” detection thresholds likely reflect the upper limit of phase synchronous activity in the brainstem. The procedure has potential applications in investigating impaired binaural processing because phase statistic applied to single epoch MEG data allowed individual thresholds to be obtained. [ABSTRACT FROM AUTHOR]

A recurring problem in aging research is separating the effects of age per se from the effects of high-frequency hearing loss. One approach is to present test stimuli in the presence of a high-pass masker to control confounding differences in high-frequency audibility across age groups. However, there is evidence that such maskers may affect older and younger listeners differently. In this study, pure-tone thresholds were measured for younger and older listeners in the presence of high-pass maskers. The age groups were carefully selected based on similar unmasked thresholds at each frequency. Thresholds were measured in quiet and in seven masker conditions. Both younger and older listeners showed increased threshold shift below the masker passband as the masker level increased. The degree of threshold shift was not greater for older versus younger listeners. Results suggest that high-pass maskers may be used to reduce high-frequency sensitivity differences between younger and older listeners without introducing differential masking effects. [ABSTRACT FROM AUTHOR]

Background: The projected increase in the aging population raises concerns about how to manage the health-care needs in a cost-effective way. Within hearing health care, there are presently too few audiologists to meet the expected demand, and training more professionals may not be a feasible way of addressing this problem. For this reason, there is a need to develop different ways of assessing hearing sensitivity that can be conducted accurately and inexpensively when a certified audiologist and/or sound-attenuated booth is unavailable. More specifically, there is a need to determine if the Etymotic Home Hearing Test (HHT) can yield accurate and reliable data from older adults with varying degrees of hearing loss. Purpose: To compare audiometric thresholds obtained using the HHT, an automated pure-tone air-conduction test, to those obtained using manual audiometry (MA), among older adults with varying degrees of hearing loss. Study Sample: Participants were 112 English-speaking adults (58% Female), aged 60 yr and older. Participants were excluded from this study if otoscopy revealed cerumen impaction and/or suspected ear pathology. Intervention: All participants completed the HHT on tablet computers in a carpeted classroom and MA in a double-walled sound-attenuated booth using insert earphones for both measures. Both measures were completed in the same test session, and the order of testing (MA versus HHT) was counterbalanced. Data Collection and Analysis: Absolute differences in threshold measurements (in dB HL) were calculated across all ears (n = 224 ears) and for all frequencies (octave frequencies from 0.5 to 8 kHz). Correlation and multiple linear regression analyses were conducted to determine if thresholds obtained using the HHT significantly correlated with thresholds using MA. Mean thresholds for each method (HHT and MA) were compared using correlation analyses for each test frequency. Multiple linear regression analysis was used to examine the relationship between the four-frequency pure-tone average (PTA) (average threshold at 0.5, 1, 2, and 4 kHz) in the better-hearing ear measured using the HHT and a set of seven independent factors: four-frequency PTA in the better-hearing ear measured via MA, treatment group (HHT versus MA), age, gender, and degree of hearing loss (mild, moderate, and >moderate). Results: Correlation analyses revealed significant frequency-specific correlations, ranging from 0.91 to 0.97 (p < 0.001), for air-conduction thresholds obtained using the HHT and MA. Mean HHT thresholds were significantly correlated with mean MA thresholds in both ears across the frequency range. This relationship held true across different degrees of hearing loss. The regression model accounted for a significant amount of variance in the HHT better-ear PTA, with MA better-ear PTA being the only significant predictor in our final model, with no effect of degree of loss, age, or gender. Conclusions: The HHT is an accurate and cost-effective method of establishing pure-tone air-conduction thresholds, when compared with MA. Therefore, the HHT can be used as a tool to acquire accurate air-conduction hearing thresholds from older adults, in-group settings, without the use of a sound-attenuated booth or a certified audiologist. [ABSTRACT FROM AUTHOR]

Older adults often have difficulty understanding speech in a noisy environment or with multiple speakers. In such situations, binaural hearing improves the signal-to-noise ratio. How does this binaural advantage change with increasing age? Using magnetoencephalography, we recorded cortical activity evoked by changes in interaural phase differences of amplitude-modulated tones. These responses occurred for frequencies up to 1225 Hz in young subjects but only up to 940 Hz in middle-aged and 760 Hz in older adults. Behavioral thresholds also decreased with increasing age but were more variable, likely because some older adults make effective use of compensatory mechanisms. The reduced frequency range for binaural hearing became significant in middle age, before decline in hearing sensation and the morphology of cortical responses, which became apparent only in the older subjects. This study provides evidence from human physiological data for the early onset of biological aging in binaural hearing. [ABSTRACT FROM AUTHOR]