Oliver Profant

Age-related changes in the central auditory system

Aging is accompanied by the deterioration of hearing that complicates our understanding of speech, especially in noisy environments. This deficit is partially caused by the loss of hair cells as well as by the dysfunction of the stria vascularis. However, the central part of the auditory system is also affected by processes accompanying aging that may run independently of those affecting peripheral receptors. Here, we review major changes occurring in the central part of the auditory system during aging. Most of the information that is focused on age-related changes in the central auditory system of experimental animals arises from experiments using immunocytochemical targeting on changes in the glutamic-acid-decarboxylase, parvalbumin, calbindin and calretinin. These data are accompanied by information about age-related changes in the number of neurons as well as about changes in the behavior of experimental animals. Aging is in principle accompanied by atrophy of the gray as well as white matter, resulting in the enlargement of the cerebrospinal fluid space. The human auditory cortex suffers not only from atrophy but also from changes in the content of some metabolites in the aged brain, as shown by magnetic resonance spectroscopy. In addition to this, functional magnetic resonance imaging reveals differences between activation of the central auditory system in the young and old brain. Altogether, the information reviewed in this article speaks in favor of specific age-related changes in the central auditory system that occur mostly independently of the changes in the inner ear and that form the basis of the central presbycusis.

Diffusion tensor imaging and MR morphometry of the central auditory pathway and auditory cortex in aging.

Age-related hearing loss (presbycusis) is caused mainly by the hypofunction of the inner ear, but recent findings point also toward a central component of presbycusis. We used MR morphometry and diffusion tensor imaging (DTI) with a 3T MR system with the aim to study the state of the central auditory system in a group of elderly subjects (>65years) with mild presbycusis, in a group of elderly subjects with expressed presbycusis and in young controls. Cortical reconstruction, volumetric segmentation and auditory pathway tractography were performed. Three parameters were evaluated by morphometry: the volume of the gray matter, the surface area of the gyrus and the thickness of the cortex. In all experimental groups the surface area and gray matter volume were larger on the left side in Heschls gyrus and planum temporale and slightly larger in the gyrus frontalis superior, whereas they were larger on the right side in the primary visual cortex. Almost all of the measured parameters were significantly smaller in the elderly subjects in Heschls gyrus, planum temporale and gyrus frontalis superior. Aging did not change the side asymmetry (laterality) of the gyri. In the central part of the auditory pathway above the inferior colliculus, a trend toward an effect of aging was present in the axial vector of the diffusion (L1) variable of DTI, with increased values observed in elderly subjects. A trend toward a decrease of L1 on the left side, which was more pronounced in the elderly groups, was observed. The effect of hearing loss was present in subjects with expressed presbycusis as a trend toward an increase of the radial vectors (L2L3) in the white matter under Heschls gyrus. These results suggest that in addition to peripheral changes, changes in the central part of the auditory system in elderly subjects are also present; however, the extent of hearing loss does not play a significant role in the central changes.

Functional Changes in the Human Auditory Cortex in Ageing

Hearing loss, presbycusis, is one of the most common sensory declines in the ageing population. Presbycusis is characterised by a deterioration in the processing of temporal sound features as well as a decline in speech perception, thus indicating a possible central component. With the aim to explore the central component of presbycusis, we studied the function of the auditory cortex by functional MRI in two groups of elderly subjects (>65 years) and compared the results with young subjects (<lt;30 years). The elderly group with expressed presbycusis (EP) differed from the elderly group with mild presbycusis (MP) in hearing thresholds measured by pure tone audiometry, presence and amplitudes of transient otoacoustic emissions (TEOAE) and distortion-product oto-acoustic emissions (DPOAE), as well as in speech-understanding under noisy conditions. Acoustically evoked activity (pink noise centered around 350 Hz, 700 Hz, 1.5 kHz, 3 kHz, 8 kHz), recorded by BOLD fMRI from an area centered on Heschl’s gyrus, was used to determine age-related changes at the level of the auditory cortex. The fMRI showed only minimal activation in response to the 8 kHz stimulation, despite the fact that all subjects heard the stimulus. Both elderly groups showed greater activation in response to acoustical stimuli in the temporal lobes in comparison with young subjects. In addition, activation in the right temporal lobe was more expressed than in the left temporal lobe in both elderly groups, whereas in the young control subjects (YC) leftward lateralization was present. No statistically significant differences in activation of the auditory cortex were found between the MP and EP groups. The greater extent of cortical activation in elderly subjects in comparison with young subjects, with an asymmetry towards the right side, may serve as a compensatory mechanism for the impaired processing of auditory information appearing as a consequence of ageing.

Metabolic changes in the auditory cortex in presbycusis demonstrated by MR spectroscopy

In humans, aging is accompanied by the deterioration of the hearing function--presbycusis. The major etiology for presbycusis is the loss of hair cells in the inner ear; less well known are changes in the central auditory system. Therefore, we used 1H magnetic resonance spectroscopy at 3T tomograph to examine metabolite levels in the auditory cortex of three groups of subjects: young healthy subjects less than 30 years old and subjects older than 65 years either with mild presbycusis corresponding to their age or with expressed presbycusis. Hearing function in all subjects was examined by pure tone audiometry (125-16,000 Hz). Significant differences were found in the concentrations of glutamate and N-acetylaspartate, with lower levels in aged subjects. Lactate was particularly increased in subjects with expressed presbycusis. Significant differences were not found in other metabolites, including GABA, between young and elderly subjects. The results demonstrate that the age-related changes of the inner ear are accompanied by a decrease in the excitatory neurotransmitter glutamate as well as a lactate increase in the auditory cortex that is more expressed in elderly subjects with large hearing threshold shifts.

The response properties of neurons in different fields of the auditory cortex in the rat.

The auditory cortex (AC) of the rat has been the subject of many studies, yet the details of its functional organization are still not well understood. We describe here the functional organization of the AC in young rats (strain Long Evans, aged 30-35 days, anesthetized with ketamine/xylazine) on the basis of the neuronal responses to acoustic stimuli. Based on the neuronal responses to broad band noise (BBN) and pure tone bursts, the AC may be divided into the primary auditory cortex (AI) and three other core fields: anterior (AAF), suprarhinal (SRAF) and posterior (PAF) as well as an unspecific region (UR) inserted between the AI and AAF. The core fields are surrounded by a belt area. Neurons in the AI, AAF, SRAF and PAF showed well defined characteristic frequencies (CF) in response to pure tone stimulation; in contrast, UR neurons responded only at high intensities without a clear CF. Neurons responding only to BBN stimulation were found mostly in the belt area. The putative borders between the core fields were determined by changes in their tonotopic gradient; however, no tonotopic organization was found in the PAF. Neurons with the shortest response latencies to BBN stimulation were found in layer 4 (L4) and layer 6 (L6) in the AI, while those with the longest latencies in the superficial layers (L1/2) of the belt area. Similar principles of responsiveness were observed when the spike rate in response to BBN stimulation was evaluated, with the highest rate present in L4 of the AI and the lowest in L1/2 of the belt area. According to the shape of the peristimulus time histograms, the responses of neurons in the AC of the rat may be classified as pure onset, sustained, onset-sustained, double peak or late onset. The most dominant in all fields, as well as in all layers, was the pure onset response. Our findings offer further cues for understanding the functional organization of the AC in the rat.

Complications of Microsurgery of Vestibular Schwannoma

Background. The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery. Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

Electron microscopy changes of cochlear implant electrodes with permanently high impedances

Abstract Objective Impedance measurements by means of telemetry have provided us with an objective test of cochlear implant function. Unmeasurable impedance suggests a possible defect on the corresponding channel of the electrode. However, increasing impedances could suggest inflammatory and/or proliferating processes along the electrode. In this report we examined correlations between high impedance, measured in vivo and in vitro findings on the electrode surfaces. Method We describe recurrent increases in cochlear implant electrode impedance in the same channels, which could initially be reversed by reprogramming the implant, and with anti-inflammatory treatment using cortisone and antibiotics. Subsequently, however, the impedances remained consistently high, indicating a cochlear implant defect. After the removal of the cochlear implant, the electrodes were examined using light and scanning electron microscopy. Results Examination of the electrodes with normal impedance values revealed, in the great majority of the electrodes, silver shining surfaces. On the other hand, electrodes with high impedances were found coated with tissue. Further analysis of these electrodes using scanning electron microscopy also demonstrated surface changes. Discussion Persistently high impedances were related to changes on the electrodes’ surface and to coating with tissue in this case. These changes can result in adhesive processes and technical malfunction, leading to explantation and difficult re-implantation. Therefore, close and professional supervision of cochlear implant patients is needed.

The age dependence of T2 relaxation times of N-acetyl aspartate, creatine and choline in the human brain at 3 and 4T

Knowledge of the T2 age dependence is of importance for MRS clinical studies involving subject groups with a wide age range. A number of studies have focused on the age dependence of T2 values in the human brain, with rather conflicting results. The aim of this study was to analyze the age dependence of T2 values of N‐acetyl aspartate (NAA), creatine (Cr) and choline (Cho) in the human brain using data acquired at 3T and 4T and to assess the influence of the macromolecule (MM) baseline handling on the obtained results.

Does Attempt at Hearing Preservation Microsurgery of Vestibular Schwannoma Affect Postoperative Tinnitus

Background. The aim of this study was to analyze the effect of vestibular schwannoma microsurgery via the retrosigmoid-transmeatal approach with special reference to the postoperative tinnitus outcome. Material and Methods. A prospective study was performed in 89 consecutive patients with unilateral vestibular schwannoma indicated for microsurgery. Patient and tumor related parameters, pre- and postoperative hearing level, intraoperative findings, and hearing and tinnitus handicap inventory scores were analyzed. Results. Cochlear nerve integrity was achieved in 44% corresponding to preservation of preoperatively serviceable hearing in 47% and useful hearing in 21%. Main prognostic factors of hearing preservation were grade/size of tumor, preoperative hearing level, intraoperative neuromonitoring, tumor consistency, and adhesion to neurovascular structures. Microsurgery led to elimination of tinnitus in 66% but also new-onset of the symptom in 14% of cases. Preservation of useful hearing and neurectomy of the eighth cranial nerve were main prognostic factors of tinnitus elimination. Preservation of cochlear nerve but loss of preoperative hearing emerged as the main factor for tinnitus persistence and new onset tinnitus. Decrease of THI scores was observed postoperatively. Conclusions. Our results underscore the importance of proper pre- and intraoperative decision making about attempt at hearing preservation versus potential for tinnitus elimination/risk of new onset of tinnitus.

Auditory dysfunction in patients with Huntington’s disease

OBJECTIVE Huntingtons disease (HD) is an autosomal, dominantly inherited, neurodegenerative disease. The main clinical features are motor impairment, progressive cognitive deterioration and behavioral changes. The aim of our study was to find out whether patients with HD suffer from disorders of the auditory system. METHODS A group of 17 genetically verified patients (11 males, 6 females) with various stages of HD (examined by UHDRS - motor part and total functional capacity, MMSE for cognitive functions) underwent an audiological examination (high frequency pure tone audiometry, otoacoustic emissions, speech audiometry, speech audiometry in babble noise, auditory brainstem responses). Additionally, 5 patients underwent a more extensive audiological examination, focused on central auditory processing. The results were compared with a group of age-matched healthy volunteers. RESULTS Our results show that HD patients have physiologic hearing thresholds, otoacoustic emissions and auditory brainstem responses; however, they display a significant decrease in speech understanding, especially under demanding conditions (speech in noise) compared to age-matched controls. Additional auditory tests also show deficits in sound source localization, based on temporal and intensity cues. We also observed a statistically significant correlation between the perception of speech in noise, and motoric and cognitive functions. However, a correlation between genetic predisposition (number of triplets) and function of inner ear was not found. CONCLUSIONS We conclude that HD negatively influences the function of the central part of the auditory system at cortical and subcortical levels, altering predominantly speech processing and sound source lateralization. SIGNIFICANCE We have thoroughly characterized auditory pathology in patients with HD that suggests involvement of central auditory and cognitive areas.