Central Auditory Processing Deficits Associated with Blast Exposure

与爆炸暴露相关的中枢听觉处理缺陷

• 批准号: 8838171
• 负责人: FREDERICK J. GALLUN
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838171
• 关键词: Afghanistan; Age; Aging-Related Process; Auditory; Auditory system; Behavioral; Biological Neural Networks; Blast Cell; Brain Injuries; Central Auditory Diseases; Clinical; Complex; Conflict (Psychology); Control Groups; Data; Data Collection; Diagnosis; Disabled Persons; District of Columbia; Environment; Equipment and supply inventories; Evaluation; Exposure to; Freedom; Functional disorder; Funding; Hearing; Hearing Tests; Human Resources; Injury; Iraq; Letters; Matched Group; Measures; Medical center; Military Personnel; Participant; Patient Self-Report; Patients; Performance; Peripheral; Phase; Premature aging syndrome; Prevalence; Process; Questionnaire Designs; Rehabilitation therapy; Reporting; Research; Research Project Grants; Services; Soldier; Speech; Testing; Traumatic Brain Injury; Veterans; Voice; base; combat; functional outcomes; handicapping condition; improved; injured; neurophysiology; normal aging; operation; response

DESCRIPTION (provided by applicant): The current conflicts in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) have resulted in unprecedented rates of exposure to high-intensity blasts and resulting brain injury. Dennis (2009) reports that during 2005-2007, 68% of U.S. military personnel injured in the OEF/OIF conflicts had blast-related injuries and 28%-31% of those evacuated to Walter Reed Army Medical Center (WRAMC), Washington, DC had brain injuries. While the common focus of auditory evaluation is on damage to the peripheral auditory system, the prevalence of brain injury among those exposed to high-intensity blasts suggests that damage to the central auditory system is an equally important concern for the blast-exposed Veteran. Discussions with clinical audiologists and OEF/OIF Veterans Service Office personnel suggest that a common complaint voiced by blast-exposed Veterans is an inability to understand speech in noisy environments, even when peripheral hearing is within normal or near-normal limits (see attached letters of support). Such complaints are consistent with damage to neural networks responsible for higher-order auditory processing. This proposal is the second phase of a research project focused on examining the degree to which central auditory processing (CAP) dysfunction is a result of blast exposure. Over the initial period of funding, data collection at WRAMC and the VA RR&D National Center for Rehabilitative Auditory Research (NCRAR) established that CAP dysfunction is present in Warfighters exposed to high-intensity blasts while serving in combat. Recently blast-exposed patients with and without diagnoses of mild traumatic brain injury tested at WRAMC showed differences from controls tested at NCRAR on one or more behavioral and neurophysiological tests used to evaluate central auditory function. This project will 1) develop an accurate estimate of the prevalence of central auditory dysfunction among Veterans exposed to blasts over the past ten years, 2) identify the functional outcomes associated with abnormal performance on tests of central processing, and 3) improve understanding of the ways in which blast-exposure resembles and differs from both the normal aging process and non-blast-related TBI in terms of performance on tests of central auditory processing. Key Question 1: To what extent is CAP dysfunction observable among OEF/OIF Veterans who have been exposed to high intensity blasts? Based on preliminary data, we hypothesize that the rate of abnormal performance on behavioral and neurophysiological tests of CAP dysfunction will be higher in a group of Veterans exposed to blasts than it will be in a control group of similar ages and hearing thresholds who have not been exposed to blasts. Key Question 2: How well can behavioral and neurophysiological tests of CAP predict functional auditory deficits measured behaviorally and through self report? It is hypothesized that tests of CAP ability will predict performance in a testing situation involving multiple talkers delivering competing messages. CAP tests will also correlate with responses blast-exposed Veterans make on the Speech and Spatial Qualities of Hearing and Hearing Handicap Inventory questionnaires, designed to examine functional hearing ability in various acoustically complex environments. Key Question 3: To what extent do blast-exposed Veterans resemble older listeners and participants with mild TBI who have not been exposed to blasts in their performance on CAP tests and functional tests of hearing? It is hypothesized that comparisons of the blast-exposed group with an older group with matched pure-tone sensitivity and an age- and hearing-matched group with non-blast-related mild traumatic brain injury will be consistent with premature aging in the blast-exposed group but demonstrate substantive differences with the non-blast group.

描述（由申请人提供）： 当前在阿富汗的冲突（持久的自由行动； OEF）和伊拉克（伊拉克自由行动； OIF行动）导致了前所未有的高强度爆炸率和导致的脑损伤。丹尼斯（Dennis，2009年）报道说，在2005年至2007年期间，有68％的美国军事人员受伤/OIF冲突受伤，与爆炸有关的伤害，其中28％-31％的人撤离到华盛顿州华盛顿州沃尔特·里德陆军医疗中心（WRAMC），华盛顿，DC，DC，脑部受伤。虽然听觉评估的普遍重点是对外围听觉系统的损害，但暴露于高强度爆炸的人的脑损伤的流行表明，对中央听觉系统的损害也是爆炸暴露的老兵同样重要的关注点。与临床听力学家和OEF/OIF退伍军人服务办公室人员的讨论表明，即使外围听力在正常或接近正常的限制范围内，也无法在噪音环境中表达的常见投诉是无法理解语音的（请参阅附件的支持信）。此类投诉与负责高阶听觉处理的神经网络的损害一致。该建议是研究项目的第二阶段，该研究项目旨在研究中央听觉处理（CAP）功能障碍是爆炸暴露的结果。在最初的资金阶段，WRAMC的数据收集以及VA RR＆D国家康复性听觉研究中心（NCRAR）确定，在战斗中服役时暴露于高强度爆炸的战士中存在CAP功能障碍。最近在WRAMC测试的有或没有诊断为轻度脑损伤的爆炸暴露患者表明，在NCRAR在一种或多种行为和神经生理测试中测试的对照组有差异，用于评估中央听觉功能。该项目将1）对过去十年中暴露于爆炸的退伍军人中中央听觉功能障碍的普遍性的准确估计，2）确定与中央处理测试异常相关的功能结果，以及3）3）3）改善对爆炸型和不正常的型号的爆炸式和不合时宜的方法的理解。关键问题1：在暴露于高强度爆炸的OEF/OIF退伍军人中，CAP功能障碍在多大程度上可观察到？基于初步数据，我们假设在暴露于爆炸的退伍军人中，对瓶盖功能障碍的行为和神经生理学测试的异常性能率要高于与未暴露于爆炸的对照组和听力阈值相似的对照组。关键问题2：CAP的行为和神经生理测试如何预测在行为和自我报告上测量的功能听觉缺陷？假设CAP能力测试将在测试情况下预测涉及多个传达竞争信息的测试情况的​​性能。帽子测试还将与爆炸暴露的退伍军人对听力和听力障碍库存问卷的语音和空间质量的回答相关，该问卷旨在检查各种声学复杂环境中的功能听力能力。关键问题3：暴露于爆炸的退伍军人在多大程度上类似于老年听众和与轻度TBI的参与者，他们在帽子测试和听力功能测试中尚未受到爆炸的暴露？假设，与纯正敏感性相匹配的较旧组的爆炸型组和与非激发性轻度外伤性脑损伤的年龄和听力匹配的组的比较将与爆炸暴露组的过早衰老一致，但与非乳突组表现出实质性差异。