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Spontaneous musical auditory perceptions in patients who develop abrupt bilateral sensorineural hearing loss. An uninhibition syndrome?
CONCLUSIONS: Spontaneous musical auditory perceptions commonly occur in patients who develop abrupt bilateral sensorineural hearing loss. The findings in both subjects who were image tested while having these perceptions are suggestive of a biological substrate for this process and of a central locus for auditory memory seemingly located in and around area 39 of Brodmann. When an individual has abrupt bilateral sensorineural hearing loss, stored musical memory can be released and this person can have musical perceptions without an external source. It is likely that an abrupt bilateral loss of inner ear function might uninhibit neuronal groups storing auditory memory. OBJECTIVES: The objectives of this study were as follows. (1) To determine if spontaneous musical auditory perceptions occur in patients who develop abrupt bilateral severe sensorineural hearing loss (not necessarily simultaneously). (2) To determine if there is a biological substrate to the process of recalling previous auditory perceptions. (3) To compare these findings with our normal databases of unstimulated and pure tone-stimulated volunteers. (4) To establish a hypothesis for the mechanisms of these occurrences. PATIENTS AND METHODS: Thirty two patients who had had abrupt bilateral severe sensorineural hearing loss (the interval between the losses of both ears could have been years) were contacted. They were asked if they had ever had the sensation of having musical auditory perceptions without external auditory stimuli. Two of these patients were image tested with single photon computerized emission tomography (neuroSPECT) while they were having these perceptions. RESULTS: All of the 32 subjects had musical auditory perceptions following their hearing loss in the second ear or when hearing loss in both ears occurred simultaneously. The two patients who were image tested with neuroSPECT had similar findings. There was a statistically significant increase in perfusion in area 39 of Brodmann, more intense on the right side, with increased perfusion also in both frontal lobes at the middle gyrus, with bilateral hypoperfusion in area 38 of Brodmann. These findings are similar to those observed in normal volunteers stimulated with pure tones.
Auditory perception during general anesthesia: psychologic consequences.
Since the introduction of general anesthesia in the middle of the 19th century, incidents of auditory perception during general anesthesia have been reported in the medical literature. Most of these reports have dealt with purely medical issues, and surprisingly little has been written on the psychologic sequelae of these instances of auditory perception. We discuss the possible psychologic consequences of such perception, and suggest methods of treatment and prevention of the negative aspects of auditory perception during general anesthesia.
Auditory perception in the child.
The development of auditory perception in the infant starts in utero and continues up to the age of 9-10 years. We shall examine the various stages, the various acoustic parameters and the segmental level. Three stages are important: from 7 months onwards: first perceptual reorganization; between 7 and 12 months: second perceptual reorganization; from 10 to 24 months: segmentation of the spoken word. We will note the evolution between 2 and 6 years and between 6 and 9 years: 9 years being the critical age--switching from global treatment to analytic treatment of utterances. We will then examine musical perception and we note that at the prelinguistic level it is the same perceptive units that handle verbal sequences and musical sequences. The stages of musical perception are parallel to those for speech. Bigand posed the question: "should we see in these hierarchies, and in their importance to perception, the manifestation of an overall cognitive constraint restricting the handling of long sequences of acoustic events (including language) and why not even for all processes dealing with symbolic information".
[Development and testing of the Heidelberg preschool screening for auditory perception and speech processing (HVS)].
There is a lack of standardized and quick tests assessing auditory perception and language processing in preschool children in German. Therefore we developed a screening for auditory perception and speech and language processing, analyzed it statistically and evaluated it in 180 children from 15 preschools. The screening comprises 7 tasks: auditory short-term memory, phonological analyses of word-initial sounds, syllable segmentation, phonological discrimination,articulatory sequencing, semantic versus phonological classification, and rhyming. Results indicated objectivity and reliability of the test. The comparison of subgroups showed that children having conductive hearing loss, deficits of articulation, deficits of language, and children otherwise considered to be unsuitable for school enrollment all showed significantly poorer achievements in different subtests than children without these problems.
A survey of speech and other auditory perception assessment materials used by cochlear implant centers.
A questionnaire assessing the various auditory perception materials used by cochlear implant centers in evaluating cochlear implant candidates and patients was developed, pilot tested, and mailed in August, 1985, to 135 cochlear implant centers. After a follow-up, there was a 45% return rate. The questionnaire sampled responses pertaining to the respondents' demographics, the types of assessment materials they used, and their opinions about speech and other auditory perception tests for evaluating cochlear implant patients. The data revealed that most centers use the same tests repeatedly for both pre- and post-implant assessments. Several factors relating to the tests and their administration were identified. Only 36% of the centers expressed satisfaction with the currently-used materials. The tests most frequently used were not necessarily considered to be the best or most appropriate for evaluating cochlear implants. Most respondents stated a need for the development of new test materials, and some suggestions were provided.
Auditory perceptions induced by low-frequency acoustic and electric stimulation.
A comparison was made between listeners' perceptions of low frequency (LF) acoustic and electric stimuli. One normal-hearing S participated, and 3 profoundly deaf pts with intracochlear electrode systems. All Ss described their auditory perceptions to pulsatile and sinusoidal stimuli from 5 to 60 c/s. LF acoustic and electric stimuli produced similar auditory perceptions; no tactual component was found to electrical stimuli, although tactual components have been reported for LF acoustic stimuli; and at 5 c/s perceptual differences were noted between pulsed and sinusoidal stimuli, differences believed to be related to the degree of neural synchrony elicited by the two types of stimulus. This study provides direct support for the theory that in normal listeners LF auditory perception is attributable to a neural volley mechanism.
Identification and discrimination disorders in auditory perception: a report on two cases.
Auditory perception was investigated in two brain-damaged subjects. The first patient had a left temporoparietal ischaemic lesion. He presented a right-ear extinction in dichotic tasks, as well as difficulties in understanding and repeating verbal material and impaired identification of melodies. All discrimination tests were well performed. The second patient had a right capsulolenticular and frontal ischaemic lesion. He presented a left ear dichotic extinction and severe difficulties in discrimination of environmental sounds and melodies but no major difficulty in naming and identification. From these results, it is hypothesized that identification and discrimination involve distinct mechanisms within the processing of auditory stimuli, and that they may be selectively disrupted in brain-damaged subjects.
[Value of cumulative electrodermal responses in subliminal auditory perception. A preliminary study].
This exploratory study examined the usefulness of averaging electrodermal potential responses for research on subliminal auditory perception. Eighteen female subjects were exposed to three kinds (emotional, neutral and 1000 Hz tone) of auditory stimulation which were repeated six times at three intensities (detection threshold, 10 dB under this threshold and 10 dB above identification threshold). Analysis of electrodermal potential responses showed that the number of responses was related to the emotionality of subliminal stimuli presented at detection threshold but not at 10 dB under it. The data interpretation proposed refers to perceptual defence theory. This study indicates that electrodermal response count constitutes a useful measure for subliminal auditory perception research, but averaging those responses was not shown to bring additional information.
Muscle contractions and auditory perception in tinnitus patients and nonclinical subjects.
Evidence has been accumulating linking subjective tinnitus to the somatosensory system. Most subjective tinnitus patients can change the psychoacoustic attributes of their tinnitus with forceful head and neck contractions. This study assessed the significance of such somatic modulation of tinnitus by testing nonclinical subjects. Like tinnitus patients, about 80% of nonclinical subjects, who had ongoing tinnitus at the time of testing (whether or not they were previously aware of it), could modulate their tinnitus with head and neck contractions. Over half of those with no tinnitus at the time of testing could elicit a tinnitus-like auditory perception with head and neck contractions. The finding that forceful head and neck contractions, as well as loud sound exposure, were significantly more likely to modulate ongoing auditory perception in people with tinnitus than in those without tinnitus supports the concept of a neural threshold for tinnitus. Somatic influences upon auditory perception are not limited to tinnitus sufferers but appear to be a fundamental property of the auditory system.
[Münchner screening of auditory perception disorders (MAUS)].
BACKGROUND: The diagnosis of APD (Auditory Perception Disorder) is a time consuming procedure. In Germany at the present, no screening test for APD exists which makes it possible to differentiate between children who are not likely to suffer from an APD and those who need to be diagnosed in detail. METHOD: The Munich Auditory Screening of Perception Disorders (MAUS) contains the following subtests: Series of Syllables, Words in Noise and Identification and Differentiation of Phonemes (test duration: 15 minutes). PATIENTS: The MAUS was standardized using 359 primary school children between 6 and 11 years of age. Furthermore, the MAUS was used in addition to the complete, extensive APD-diagnostics in testing 52 children (36 with APD and 16 without APD) within the age group mentioned. RESULTS: T-scores for each subtest were established by the standardization of the MAUS. The internal consistency of the test was sufficient. The intercorrelation between subtests was very slight. Therefore, each subtest seems to play an independent part in defining the construct of APD. Because of the results of the pilot study which formed the basis for the development of the screening instrument used, and because of the sensitivity scores reached in testing a group of 36 children with diagnosed APD, it can be expected that the MAUS will show a high sensitivity with regard to APD. CONCLUSION: Using the MAUS, it can be determined if and to what extent the test results of an individual deviate from those of the normal primary school population. The MAUS can identify children at risk of having an APD and can differentiate these children from those who are unlikely to suffer from an APD.
[Computer-assisted rehabilitation of auditory perception after cochlear implants and hearing aid management].
A newly developed computer-aided rehabilitation programme simplifies the training of auditory perception after cochlear implant or hearing-aid fitting. The programme is interactive, hierarchically structured, applicable without any computer knowledge and adjustable to individual requirements of each patient. There are two versions of the programme, one for clinical and one for home use. A transfer option provides simple data exchange of results and new training exercises via floppy disk. The present experience shows that, with this programme, auditory perception is improved more rapidly than with traditional therapy and that the patients are strongly motivated and concentrated over a long period in order "to beat the computer". The home version is appreciated for making possible schedule-free training without inconvenient and time-consuming trips to the therapist.
Preperceptual images, processing time, and perceptual units in auditory perception.
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Far-field recorded frequency-following responses: correlates of low pitch auditory perception in humans.
The recent demonstration that auditory frequency-following responses (FFR) can be recorded by signal averaging from the human scalp, opened the way for studies correlating FFR with auditory experience. This report describes FFR amplitude changes as a function of stimulus intensity and the addition of masking noise. The first experiment revealed a high degree of consistency both within and across subjects in the latency, phase and waveform of averaged FFR. This experiment also demonstrated a monotonic relationship between average FFR amplitude and stimulus intensity between 40 and 65 dB SL. Results of the second experiment showed a close correlation between the detectability of a tone in a noise masker and FFR amplitude. FFR amplitude diminishes precipitously as noise intensity approaches or exceeds the threshold for masking of the tone. These results are interpreted as emphasizing the role of neural periodicity mechanisms in the preception of low frequencies.
Generalization of conditioned suppression during salicylate-induced phantom auditory perception in rats.
Tonal frequency generalization was examined in a total of 114 pigmented male rats, 60 of which were tested under the influence of salicylate-induced phantom auditory perception, introduced before or after lick suppression training. Thirty control subjects received saline injections, and the remaining 24 subjects served as noninjected controls of tonal background effects on generalization. Rats were continuously exposed to background noise alone or with a superimposed tone. Offset of background noise alone (Experiment I), or combined with onset or continuation of the tone (Experiments II and III) served as the conditioned stimulus (CS). In Experiment I, tone presentations were introduced only after suppression training. Depending on the time of salicylate introduction, a strong and differential influence on generalization gradients was observed, which is consistent with subjects' detection of salicylate-induced, high-pitched sound. Moreover, when either 12- or 3 kHz tones were introduced before or after Pavlovian training to mimic salicylate effects in 24 rats, the distortions in generalization gradients resembled trends obtained from respective salicylate injected groups. Experiments II and III were aimed at evaluating the masking effect of salicylate-induced phantom auditory perception on external sounds, with a 5- or a 10-kHz tone imposed continuously on the noise or presented only during the CS. Tests of tonal generalization to frequencies ranging from 4- to 11- kHz showed that in this experimental context salicylate-induced perception did not interfere with the dominant influence of external tones, a result that further strengthens the conclusion of Experiment I.
Absence of both auditory evoked potentials and auditory percepts dependent on timing cues.
An 11-yr-old girl had an absence of sensory components of auditory evoked potentials (brainstem, middle and long-latency) to click and tone burst stimuli that she could clearly hear. Psychoacoustic tests revealed a marked impairment of those auditory perceptions dependent on temporal cues, that is, lateralization of binaural clicks, change of binaural masked threshold with changes in signal phase, binaural beats, detection of paired monaural clicks, monaural detection of a silent gap in a sound, and monaural threshold elevation for short duration tones. In contrast, auditory functions reflecting intensity or frequency discriminations (difference limens) were only minimally impaired. Pure tone audiometry showed a moderate (50 dB) bilateral hearing loss with a disproportionate severe loss of word intelligibility. Those auditory evoked potentials that were preserved included (1) cochlear microphonics reflecting hair cell activity; (2) cortical sustained potentials reflecting processing of slowly changing signals; and (3) long-latency cognitive components (P300, processing negativity) reflecting endogenous auditory cognitive processes. Both the evoked potential and perceptual deficits are attributed to changes in temporal encoding of acoustic signals perhaps occurring at the synapse between hair cell and eighth nerve dendrites. The results from this patient are discussed in relation to previously published cases with absent auditory evoked potentials and preserved hearing.
Automatic operant response procedure ('play-test') for the study of auditory perception of neurologically impaired infants.
Ten babies with cerebral palsy of varying types and degrees (age-range 10 to 27 months) participated in an initial exploratory study designed to determine the effectiveness of an automated, two-choice audio feedback system (Playtest') for evaluation of the auditory perception and processing capabilities of neurologically impaired infants. The major components of the 'Playtest' are a master control unit and two toy-like switches which are attached to the baby's crib. By playing with the 'toys', the baby is able to listen to one of two pre-recorded audio stimuli, music or a monotone hum. Frequency and duration of the baby's self-selected listening responses are automatically recorded on meters inside the control unit and provide a precise numerical record over an extended period of time. In this study the handicapped infants were physically able to operate the apparatus and demonstrated highly significant preferential listening. Comparison of the recorded data from the study infants with those from normal infants showed no significant difference between the performances of the two groups. The findings suggest that the 'Playtest' technique could be successfully applied to the objective assessment of auditory perception and processing abilities of neurologically impaired infants, whose handicaps often prevent them from effectively participating in other standardised test procedures. The principal advantages of the technique are that testing is done in the child's most familiar environment--his own crib at home--without the intrusion of other people, and the evaluation of hearing competence is a function of the baby's spontaneous self-selected responses to sound variables, and hence of his auditory discrimination.
Effects of recurrent otitis media in infancy on auditory perception and speech.
INTRODUCTION: Recurrent otitis media is commonly encountered in children before 3 years of age. Conductive hearing loss up to 40 dB is frequently associated with suppurative otitis media. Good hearing is believed to be critical to the development of normal language. This study was undertaken to evaluate the effect of recurrent otitis media on auditory perception and speech. PATIENTS AND METHODS: The experimental group consisted of 33 children with a history of at least three episodes of acute otitis media before 2 years of age. A control group of 29 children experienced one or fewer episodes of otitis media in the first 2 years of age. At the time of investigation, all children were 8 to 10 years of age and had attended similar pre-school, kindergarten, and elementary school programs. None showed evidence of mental retardation nor behavioral or emotional disorders. Speech ability was assessed by a battery of tests specific for Slovene language. Subtests of the Wechsler Intelligence Scale for Children were used as well as the Reading and Writing Test. RESULTS: Auditory perception disorders were evident in 88% of children investigated who had a history of at least three episodes of otitis media by 2 years of age. Decreased auditory stimulation during the time of auditory maturation could prevent the development of these functions completely. No statistically significant differences were observed in the development of articulation. These observations underscore the importance of early management of recurrent otitis media during the first 2 years of age.