Hearing complaints in HIV infection originate in the brain not the ear

Buckey, Jay C.; Fellows, Abigail; Magohe, Albert; Maro, Isaac; Gui, Jiang; Clavier, Odile; Massawe, Enica Richard; Moshi, Ndeserua

doi:10.1097/qad.0000000000002229

Cited by 15 publications

(33 citation statements)

References 11 publications

(19 reference statements)

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“…A variety of studies have hypothesized that HIV, while present in the CNS, has its direct effect on the vestibular and cochlear system as well as more central auditory processing pathways (13, 27, 28). As demonstrated by Matas et al and Maro et al MLR latencies and gap detection thresholds were prolonged as a measurement for central auditory processing (2, 13).…”

Section: Discussionmentioning

confidence: 99%

Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints

Luder

2019

Front. Neurol.

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Objective: Hearing abnormalities frequently occur in Human Immunodeficiency Virus (HIV) infected individuals. Both conductive and uni- or bilateral sensorineural hearing loss (SNHL) have been described along with other audiological and vestibular symptoms such as tinnitus, vertigo and balance disturbances. While frequent middle ear infections may explain impairment of peripheral hearing abilities, the exact etiology of cochlear, and central auditory processing deficits still remains unclear. Direct effects of HIV, opportunistic infections, ototoxic side effects of antiretroviral therapy (ART), and immunologic responses to the central nervous system involving the auditory pathway have been proposed. We aim to review the audiological profile in HIV infected adults related to the effects of HIV and HAART on the inner ear structures. Methods: We present a review of the literature on cases of HIV related SNHL in adult patients and studies conducted to investigate audiometric changes in such patients. Data on presentation, diagnosis and pathophysiology were reviewed. Results: Sensorineural hearing loss in the higher frequencies is a common form of hearing loss in HIV infected individuals throughout disease progression, along with decreased otoacoustic emission (OAE) responses, increased PTA hearing thresholds and prolonged latencies for auditory brainstem responses (ABR). Conclusion: HIV affects all stages of auditory perception in a way similar to accelerated aging of the auditory system. And we postulate that synaptic loss may be the first step, followed by cochlear damage and central pathology as the virus remains present in all the structures of the auditory pathway causing local inflammation and degeneration. Evaluation of hearing function among all patients diagnosed with HIV infection seems to be an accepted approach; it should include OAE testing, pure tone and speech audiometry, speech-in-noise tests and ABR measurements.

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Section: Discussionmentioning

confidence: 99%

Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints

Luder

2019

Front. Neurol.

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“…We also implemented an adaptive GAP test to evaluate temporal auditory processing. The adaptive gap detection algorithm applies a single staircase and has been used extensively in our previous studies [ 4 , 33 , 35 ]. In the algorithm, the gap length is shortened when the subject correctly identifies two gaps in a row.…”

Section: Methodsmentioning

confidence: 99%

“…This involves neural pathways throughout the brainstem and into the cortex that integrate with linguistic and cognitive systems, which depend on adequate processing speed, working memory, and attention [ 5 - 7 ]. In addition, previous studies have shown that HIV-positive individuals develop signs of central auditory processing that cannot be attributed to peripheral hearing loss [ 4 , 8 , 9 ]. Even with normal peripheral hearing sensitivity (eg, normal pure-tone auditory threshold test results), HIV-positive individuals show degraded results on tests of speech perception in noise [ 10 ] and auditory gap detection [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, previous studies have shown that HIV-positive individuals develop signs of central auditory processing that cannot be attributed to peripheral hearing loss [ 4 , 8 , 9 ]. Even with normal peripheral hearing sensitivity (eg, normal pure-tone auditory threshold test results), HIV-positive individuals show degraded results on tests of speech perception in noise [ 10 ] and auditory gap detection [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…This study was designed to ascertain how longitudinal performance on CATs relates to neurocognitive performance in a cohort of HIV-negative and HIV-positive individuals. We hypothesized that the diffuse white matter disease associated with HIV infection would affect central auditory processing progressively [ 4 , 32 , 33 ]. This suggests that the effects of HIV on the CNS could be tracked with CATs, which are quantitative, time-efficient, and repeatable.…”

Section: Introductionmentioning

confidence: 99%

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Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

Niemczak¹,

Fellows²,

Lichtenstein³

et al. 2021

JMIR Form Res

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Background The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

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Peripheral Auditory Function in Tanzanian Children Living With HIV With Clinically Normal Hearing

et al. 2023

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ImportanceDespite normal audiometry, adults living with HIV have lower distortion product otoacoustic emissions (DPOAEs) compared with HIV-negative controls, but the degree of these differences in children living with HIV is unknown. If subclinical auditory deficits are present, results could affect developmental outcomes in children living with HIV (CLWH).ObjectiveTo compare DPOAEs and auditory brainstem responses (ABR) between 2 age- and sex-matched groups of younger children with normal audiometry, 1 infected with HIV and the other uninfected.Design, Setting, and ParticipantsCohort study in an infectious disease center in Dar es Salaam, Tanzania. Participants included 340 Tanzanian children aged 3 to 9 years with clinically normal hearing, type A tympanograms bilaterally, and air-conduction thresholds of 20 dB HL or less from 0.5 to 8 kHz. Participants in the cohort repeated testing approximately every 6 months (approximately 2.2 sessions per participant) for a total of 744 total observations. Data were analyzed from March 2020 to January 2022.Main Outcomes and MeasuresDPOAE amplitudes from 1.5 to 8 kHz using an f2 to f1 ratio of 1.2 and L1/L2 values of 65/55 dB sound pressure level and click-evoked ABR using a slow (21.1/s) and fast (61.1/s) click rate.ResultsA total of 141 CLWH (70 female participants [49.3%]; mean [SD] age, 7.24 [1.67] years) and 199 HIV-negative individuals (99 female participants [49.7%]; mean [SD] age, 7.26 [1.44] years) participated in the study. The groups did not differ significantly in age, static immittance, or air-conduction thresholds. HIV status was independently associated with approximately 1.4 dB (95% CI, −3.28 to 0.30 dB) to 3.8 dB (95% CI, 6.03 to −1.99 dB) lower DPOAE amplitudes at 6 and 8 kHz bilaterally and 0.28 μV (95% CI, 0.01 to 0.33 μV) lower ABR wave V amplitudes in the right ear.Conclusions and RelevanceConsistent with previous findings in young adults, CLWH had slightly, but reliably, lower DPOAEs and ABR wave V amplitudes than HIV-negative controls. The magnitude of these differences was small, but results suggest an early and consistent association between HIV infection or treatment and outer hair cell and auditory brainstem responses in children as young as 3 years. These subclinical changes suggest tracking both auditory function and development outcomes in CLWH is warranted.

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Hearing complaints in HIV infection originate in the brain not the ear

Cited by 15 publications

References 11 publications

Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints

Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

Peripheral Auditory Function in Tanzanian Children Living With HIV With Clinically Normal Hearing

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