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）： 当前阿富汗（持久自由行动；OEF）和伊拉克（伊拉克自由行动；OIF）的冲突导致了前所未有的高强度爆炸暴露率并导致脑损伤。 Dennis (2009) 报告称，2005-2007 年期间，在 OEF/OIF 冲突中受伤的美国军人中有 68% 患有爆炸相关伤害，而疏散到华盛顿特区沃尔特·里德陆军医疗中心 (WRAMC) 的人员中，有 28%-31% 患有脑损伤。虽然听觉评估的共同焦点是对周围听觉系统的损害，但暴露于高强度爆炸的人中脑损伤的普遍性表明，对中枢听觉系统的损害对于暴露于爆炸的退伍军人来说同样重要。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，遭受爆炸影响的退伍军人的一个常见抱怨是无法在嘈杂的环境中理解言语，即使外围听力处于正常或接近正常范围内（请参阅随附的支持信）。这种抱怨与负责高阶听觉处理的神经网络的损害是一致的。该提案是一个研究项目的第二阶段，该项目的重点是检查爆炸暴露导致中枢听觉处理（CAP）功能障碍的程度。在资助的最初阶段，WRAMC 和 VA RR&D 国家康复听觉研究中心 (NCRAR) 收集的数据表明，在战斗中暴露于高强度爆炸的战士中存在 CAP 功能障碍。最近在 WRAMC 测试的爆炸暴露患者（诊断为轻度创伤性脑损伤或未诊断为轻度创伤性脑损伤）在一项或多项用于评估中枢听觉功能的行为和神经生理学测试中与在 NCRAR 测试的对照组存在差异。该项目将 1) 对过去十年中暴露于爆炸的退伍军人中中枢听觉功能障碍的患病率进行准确估计，2) 确定与中央处理测试中的异常表现相关的功能结果，以及 3) 提高对爆炸暴露与正常衰老过程和非爆炸相关 TBI 在中枢听觉处理测试中的表现的相似和不同方式的理解。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？根据初步数据，我们假设，暴露于爆炸物的退伍军人群体中 CAP 功能障碍的行为和神经生理学测试的异常表现率将高于未接触爆炸物的年龄和听力阈值相似的对照组。关键问题 2：CAP 的行为和神经生理学测试能在多大程度上预测通过行为和自我报告测量的功能性听觉缺陷？假设 CAP 能力的测试将预测涉及多个讲话者传递竞争消息的测试情况下的性能。 CAP 测试还将与经历过爆炸的退伍军人对听力言语和空间质量以及听力障碍调查问卷的回答相关联，该问卷旨在检查各种复杂声学环境中的功能性听力。关键问题 3：经历过爆炸的退伍军人在 CAP 测试和听力功能测试中的表现与未接触过爆炸的老年听众和患有轻度 TBI 的参与者在多大程度上相似？据推测，将爆炸暴露组与纯音敏感性匹配的老年组以及年龄和听力匹配的非爆炸相关轻度创伤性脑损伤组进行比较，将与爆炸暴露组的过早衰老一致，但与非爆炸组表现出实质性差异。