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Objective: To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD). Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifty-three adults with SSD. Intervention(s): Unilateral CI. Main Outcome Measure(s): Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs. Results: The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the “binaural with CI” condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day. Conclusions: Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

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Objectives-The purpose of this study was to obtain an electrophysiological analog of masking release using speech-evoked cortical potentials in steady and modulated maskers, and to relate this masking release to behavioral measures for the same stimuli. The hypothesis was that the evoked potentials can be tracked to a lower stimulus level in a modulated masker than in a steady masker, and that the magnitude of this electrophysiological masking release is of the same order as that of the behavioral masking release for the same stimuli. Design-Cortical potentials evoked by an 80-ms /ba/ stimulus were measured in two steady maskers (30-and 65-dB SPL), and in a masker that modulated between these two levels at a rate of 25 Hz. In each masker, a level series was undertaken to determine electrophysiological threshold. Behavioral detection thresholds were determined in the same maskers using an adaptive tracking procedure. Masking release was defined as the difference between signal thresholds measured in the steady 65-dB SPL masker and the modulated masker. A total of 23 normalhearing adults participated. Results-Electrophysiological thresholds were uniformly elevated relative to behavioral thresholds by about 6.5 dB. However, the magnitude of masking release was about 13.5 dB for both measurement domains. Conclusions-Electrophysiological measures of masking release using speech-evoked cortical auditory evoked potentials correspond closely to behavioral estimates for the same stimuli. This suggests that objective measures based on electrophysiological techniques can be used to reliably gauge aspects of temporal processing ability.

To make sense of our ever-changing world, our brains search out patterns. This drive can be so strong that the brain imposes patterns when there are none. The opposite can also occur: The brain can overlook patterns because they do not conform to expectations. In this study, we examined this neural sensitivity to patterns within the auditory brainstem, an evolutionarily ancient part of the brain that can be fine-tuned by experience and is integral to an array of cognitive functions. We have recently shown that this auditory hub is sensitive to patterns embedded within a novel sound stream, and we established a link between neural sensitivity and behavioral indices of learning [Skoe, E., Krizman, J., Spitzer, E., & Kraus, N. The auditory brainstem is a barometer of rapid auditory learning. Neuroscience, 243, 104-114, 2013]. We now ask whether this sensitivity to stimulus statistics is biased by prior experience and the expectations arising from this experience. To address this question, we recorded complex auditory brainstem responses (cABRs) to two patterned sound sequences formed from a set of eight repeating tones. For both patterned sequences, the eight tones were presented such that the transitional probability (TP) between neighboring tones was either 33% (low predictability) or 100% (high predictability). Although both sequences were novel to the healthy young adult listener and had similar TP distributions, one was perceived to be more musical than the other. For the more musical sequence, participants performed above chance when tested on their recognition of the most predictable two-tone combinations within the sequence (TP of 100%); in this case, the cABR differed from a baseline condition where the sound sequence had no predictable structure. In contrast, for the less musical sequence, learning was at chance, suggesting that listeners were "deaf" to the highly predictable repeating two-tone combinations in the sequence. For this condition, the cABR also did not differ from baseline. From this, we posit that the brainstem acts as a Bayesian sound processor, such that it factors in prior knowledge about the environment to index the probability of particular events within ever-changing sensory conditions.