Awakening the Auditory System: Binaural Benefit Revisited

6th International Pediatric Audiology Conference: Dec. 9. 2013

Awakening the Auditory

System: Binaural Benefit

Revisited

Blake C. Papsin

Cochlear Implant Team 2013-2014

Gina Goulding

Naureen Sohail

Laurie MacDonald

Patt Fuller

Adrian James

Mary Lynn Feness

Pat Di Santos

Nancy Greenwald-Hood

Susan Druker

Blake Papsin

Vicky Papaioannou

Karen Gordon

Sharon Cushing

Valerie Simard

Rebecca Malcomson

Joelene Huber

Gillian Lieberman

Stephanie Jewell

Introduction

plasticity and evolution

feature extraction

the senses

stereoscopy/binaural hearing

awakening the auditory system

Plasticity Evolved

Biston betularia f. typica Biston betularia f. carbonaria

Human = Information Processor

olfaction

vision

motor skill

audition

linguistic ability

executive function

olfaction

vision

motor skill

audition

linguistic ability

executive function

olfaction

vision

motor skill

audition

linguistic ability

executive function

IQ = 107 IQ = 7

Reduced

activity

Activity no

longer reduced

Lee, et al., Nature, 2001

Auditory Cortex in Silence

Auditory Plasticity (Learning)

↑ representation of 8-16 kHz octave band

(Stanton & Harrison 1996)

Capitalizing on Plasticity

Age (months)

0 10 20 30 40 50

6-12 months

12-18 months

19-23 months

Normal hearing

6-12 months

Ongoing Plasticity

adult map reorganization reported:

If animal is trained to attend to the stimulus

(Polley, Steinberg & Merzenich, 2006)

The Three Questions

do I run from it?

do I eat it?

do I mate with it?

Feature Extraction - Senses

extract data

collect data

assemble data

Sensory Reassembly

illusory

reassemble the

world – most

probable state

Sensory Reassembly

illusory

reassemble the

world – most

probable state

Senses

illusory

reassemble the

world – most

probable state

Vision and Audition

fundamentally different

separate pathways

temporal relationships

Vision and Audition

separate pathways

lateral geniculate nucleus

Vision and Audition

separate pathways

visual time

Auditory time

Feature Extraction

saccades scan visual

environment

Vision and Audition

separate pathways

visual time

Auditory time

Auditory Processing

must process

environment in

one pass

extract

identify

categorize

Auditory System

Importance of Stereoscopy

the slight differences between the two

eyes define orientation in space

Development of Stereoscopy

Hubel and Wiesel

patched one side

= all input neurons to one eye

patched both sides

= all inputs neurons active

Can You “Patch” an Ear?

paths cross early

hearing occurs in

conductive loss

models

lateral lemniscus

You Can “Patch” an Ear!

paths cross early

hearing occurs in

conductive loss

models

And You Can “Unpatch” an Ear!

paths cross early

hearing occurs in

conductive loss

models

Studying Binaural Perception

Lateralization Index = (R-L)/(R+L)

Wong et al. IEEE (2010)

Reorganization of Auditory Cortex

-50 -40 -30 -20 -10 0 10 20 30 40 50

Normal

Simultaneous

Short Delay

Long Delay

Lateralization %

Particip

Lateralization of Cortical Responses by Stimulus Side

Left/CI-2 Stim

Bilateral

Right/CI-1 Stim

Left cortex Right cortex

* P<0.05

Long Delay

(> 2 years)

Short Delay

(< 1.5 years)

Simultaneous

Normal

Hearing

Lateralization of auditory activity (%) Gordon et al. Brain (2013)

Reorganization of Auditory Cortex

-50 -40 -30 -20 -10 0 10 20 30 40 50

Normal

Simultaneous

Short Delay

Long Delay

Lateralization %

Particip

Lateralization of Cortical Responses by Stimulus Side

Left/CI-2 Stim

Bilateral

Right/CI-1 Stim

Left cortex Right cortex

* P<0.05

Long Delay

(> 2 years)

Short Delay

(< 1.5 years)

Simultaneous

Normal

Hearing

Lateralization of auditory activity (%) Gordon et al. Brain (2013)

Summary

sequential bilateral cochlear implantation

allows asymmetric auditory development

compromises binaural processing in the auditory

cortex

Summary

simultaneous bilateral cochlear implantation

promotes symmetric auditory brainstem

development

protects the auditory cortex from reorganized

lateralization

There is a Bilateral Advantage

...But Then it Disappears!

Jewell et al. In Press

Asymmetric Speech Perception

Jewell et al. In Press

Asymmetry & Bilateral Benefit

Absolute Difference Between Ears (%) Jewell et al. In Press

Signal Noise Noise Signal

Noise Signal Signal Noise

Binaural Hearing

Children Need Binaural Hearing

Calculation: spatial unmasking

(noise at 0°) vs. (noise at 90°)

Calculation: spatial unmasking

(noise at 0°) vs. (noise at 90°)

sequential simultaneous normal

Noise moved to 1st implanted ear

Noise moved to 2nd implanted ear

Bilateral CI Bilateral CI

Benefits of Simultaneous Bilateral Hearing

P>0.05 P=0.001

Chadha et al. Otol Neurotol (2013)

Results: Inter-aural/implant Level Differences

Left +20 dB +10 dB 0 dB -10 dB -20 dB Right

ILD Condition

Normal Hearing)

CI2 +20 CU+10 CU 0 CU -10 CU -20 CU CI1

ILD Condition

CI - Sequential

Salloum et al. Ear & Hearing (2010)

Results: Inter-aural/implant Level Differences

Left +20 dB +10 dB 0 dB -10 dB -20 dB Right

ILD Condition

Normal Hearing)

CI2 +20 CU+10 CU 0 CU -10 CU -20 CU CI1

ILD Condition

CI - Sequential

Left +20CU

0 -2CU

Response R

ILD Condition

CI - Simultaneous

Salloum et al. Ear & Hearing (2010)

Deighton et al. In Press (2013)

Results: Inter-aural/implant Timing Differences

ITD Condition

Normal Hearing

ITD Condition

CI-Sequential

Results: Inter-aural/implant Timing Differences

ITD Condition

Normal Hearing

ITD Condition

CI-Sequential

+2000US

+1000us

+400us

0 -400 us -1000us

-2000us

Response R

ITD Condition

CI - Simultaneous

Increased Effort & Increased P2 Amplitude

Cochlear Implant Users(n=24)

Normal Hearing Peers(n=23)

Auditory Auditory-Visual

Increased reaction time - emotions in speech

** ** p<0.01

Hopyan et al. Child Neuropsychology (2009)

Tremblay et al. Clinical Neurophysiology (2009)

P2 Amplitude after auditory training

Jiwani et al. Clinical Neurophysiology (2013)

Gordon et al. Frontiers in Auditory Cognitive Neuroscience (2013)

Reassembling the Auditory

Environment

Summary

aggressive bilateral cochlear stimulation

promotes:

symmetric auditory brainstem development

spatial unmasking

binaural processing

does not result in improved speech perception

in test conditions

Edge of the Envelope

auditory cortex develops “normally” with

bilateral stimulation

short period of deprivation (in children)

study children implanted with short periods of

deprivation

asymmetric hearing loss

unilateral hearing loss

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