Frontal-auditory cortical interactions and sensory prediction during vocal production in marmoset monkeys

Current Biology · 2025-04-17 · 5 citations

Evaluating Adverse Outcomes After Myringotomy or Tube Placement in Head and Neck Cancer

Otolaryngology · 2025-03-19

OBJECTIVE: Evaluate rates of adverse outcomes among patients with a history of head and neck cancer undergoing myringotomy with or without tube placement for middle ear effusion. STUDY DESIGN: Retrospective chart review. SETTING: Academic medical center. METHODS: Retrospective chart review was performed on patients undergoing myringotomy with or without tube placement for middle ear effusion between 2018 and 2022. Data reviewed included demographics, cancer history, audiometry, and clinical course. RESULTS: In total, 578 patients (736 ears) had a mean follow-up of 36.6 months: 84 (14.53%) were in the cancer cohort. On average, cancer patients were older (62.6 vs 59.3 years, P < .05) but had similar rates of overall adverse outcomes (44.05% vs 44.13%, P = 1.0). Rates of persistent perforation were higher among cancer patients (14.29% vs 2.43%, P < .001); there was no significant difference in rates of recurrent effusion (5.95% vs 4.66%; P = .81). Postpropensity score matching, perforation rates reached statistical significance (14.29% vs 1.22%, P < .01). There was no difference in rate of adverse events for overall events (44.05% vs 47.56%, P = .77) or recurrent effusion (5.95% vs 1.22%, P = .22). CONCLUSION: Patients with a history of head and neck cancer or radiation have a three-to-five-fold risk of persistent tympanic membrane perforation after myringotomy with or without tube placement and a higher rate of recurrent effusion that is not significant. In multivariate analysis, perforation risk was revealed to be multifactorial.

Vocal Error Monitoring in the Primate Auditory Cortex

Journal of Neuroscience · 2025-07-11 · 2 citations

Sensory-motor control requires the integration and monitoring of sensory feedback resulting from our behaviors. This self-monitoring is thought to result from comparisons between predictions about the expected sensory consequences of action and the feedback actually received, resulting in activity that encodes feedback error. Although similar mechanisms have been proposed during speech and vocal production, including sensitivity to experimentally perturbed auditory feedback, evidence for a vocal "error signal" has been limited. Here, we recorded from the auditory cortex of vocalizing nonhuman primates, using real-time frequency shifts to introduce feedback errors of varying magnitude and direction. We found neural activity that scaled with the magnitude of feedback error in both directions, consistent with vocal error monitoring at both the individual unit and population levels. This feedback sensitivity was greater than expected based upon passive sensory responses and was specific for units in the vocal frequency range. Feedback responses also predicted subsequent compensatory changes in vocal production. These results provide evidence that the auditory cortex encodes the degree of vocal feedback error using both unit-level error calculations and changes in the population of neurons involved. These mechanisms may provide critical error information necessary for feedback-dependent vocal control.

Reassessing the Utility of Surgical Intervention for Skull Base Osteomyelitis: A 16‐Year Experience

Otolaryngology · 2024-02-12 · 2 citations

OBJECTIVE: The role of surgery in lateral skull base osteomyelitis (SBO) is controversial. Surgical intervention is often requested by consulting services in the interest of additional culture data to inform medical management. However, whether surgery alters subsequent antibiotic treatment or modifies disease outcome remains unknown. The aim of this study was to investigate the role of surgical intervention in the treatment of SBO by (1) comparing nonsurgical and surgical culture data and (2) assessing clinical outcomes and treatment course following surgical intervention. STUDY DESIGN: Retrospective. SETTING: Tertiary care center. METHODS: The electronic record was queried for all patients with SBO who presented to a single institution over a 16-year period (2007-2023). Information recorded included history and exam, bedside and intraoperative culture data, antibiotic course, and disease outcomes. Primary outcome measures included change in medical management based on intraoperative cultures, recurrence rates, and mortality rates. RESULTS: Forty patients (41 ears, average age 73 ± 13 years) met inclusion criteria. Out of 13 (32%) patients who underwent surgical intervention, one intraoperative culture changed the antibiotic course due to identification of resistance to the original antibiotic used. Surgery did not demonstrate a benefit in overall mortality (23% vs 18%, P = 0.36) or facial nerve function (33% vs 50%, P = 0.56) compared to medical management, and was associated with increased recurrence rates (54% vs 11%, P = 0.05). CONCLUSION: Surgical cultures rarely changed antibiotic selection. Surgical debridement in treatment-refractory SBO was also not associated with improvement in recurrence or mortality rates, though this may reflect underlying differences in disease severity.

Frontal-Auditory Cortical Interactions and Sensory Prediction During Vocal Production in Marmoset Monkeys

bioRxiv (Cold Spring Harbor Laboratory) · 2024-01-29 · 2 citations

The control of speech and vocal production involves the calculation of error between the intended vocal output and the resulting auditory feedback. Consistent with this model, recent evidence has demonstrated that the auditory cortex is suppressed immediately before and during vocal production, yet is still sensitive to differences between vocal output and altered auditory feedback. This suppression has been suggested to be the result of top-down signals containing information about the intended vocal output, potentially originating from motor or other frontal cortical areas. However, whether such frontal areas are the source of suppressive and predictive signaling to the auditory cortex during vocalization is unknown. Here, we simultaneously recorded neural activity from both the auditory and frontal cortices of marmoset monkeys while they produced self-initiated vocalizations. We found increases in neural activity in both brain areas preceding the onset of vocal production, notably changes in both multi-unit activity and local field potential theta-band power. Connectivity analysis using Granger causality demonstrated that frontal cortex sends directed signaling to the auditory cortex during this pre-vocal period. Importantly, this pre-vocal activity predicted both vocalization-induced suppression of the auditory cortex as well as the acoustics of subsequent vocalizations. These results suggest that frontal cortical areas communicate with the auditory cortex preceding vocal production, with frontal-auditory signals that may reflect the transmission of sensory prediction information. This interaction between frontal and auditory cortices may contribute to mechanisms that calculate errors between intended and actual vocal outputs during vocal communication.

Multiple processes of vocal sensory-motor interaction in primate auditory cortex

Nature Communications · 2024-04-10 · 11 citations

Sensory-motor interactions in the auditory system play an important role in vocal self-monitoring and control. These result from top-down corollary discharges, relaying predictions about vocal timing and acoustics. Recent evidence suggests such signals may be two distinct processes, one suppressing neural activity during vocalization and another enhancing sensitivity to sensory feedback, rather than a single mechanism. Single-neuron recordings have been unable to disambiguate due to overlap of motor signals with sensory inputs. Here, we sought to disentangle these processes in marmoset auditory cortex during production of multi-phrased 'twitter' vocalizations. Temporal responses revealed two timescales of vocal suppression: temporally-precise phasic suppression during phrases and sustained tonic suppression. Both components were present within individual neurons, however, phasic suppression presented broadly regardless of frequency tuning (gating), while tonic was selective for vocal frequencies and feedback (prediction). This suggests that auditory cortex is modulated by concurrent corollary discharges during vocalization, with different computational mechanisms.

Toward a Diagnostic Imaging Algorithm for Undifferentiated Pulsatile Tinnitus

Otology & Neurotology · 2024-07-25 · 1 citations

OBJECTIVE: Decisions around the diagnostic evaluation for pulsatile tinnitus (PT) remain challenging. We describe the usage patterns and diagnostic accuracy of imaging modalities and propose an evidence-based diagnostic approach for undifferentiated PT. STUDY DESIGN: Retrospective. SETTING: Single otology/neurotology clinic. SUBJECTS: Patients with PT presenting between 2009 and 2020. MAIN OUTCOME MEASURES: Sensitivity, specificity, diagnostic yield, and diagnostic accuracy. RESULTS: A total of 315 subjects met inclusion criteria (74% female, mean ± SD age = 52 ± 17 years). Subjects were divided into four cohorts based on exam findings: normal (n = 229), venous cohort (n = 34), arterial cohort (n = 16), and outer/middle ear pathology cohort (n = 40). In total, 53% of patients received a nonidiopathic diagnosis for PT. The most common identifiable cause was sigmoid sinus dehiscence (78%) in the venous cohort, carotid stenosis (36%) in the arterial cohort, and glomus tumor (56%) in the outer/middle ear pathology cohort. There was a higher diagnostic rate among patients with positive exam findings compared to those with unrevealing exams ( p = 0.04). Imaging studies with the highest diagnostic yield were computed tomography (CT) venography (44%), formal angiography (42%), and magnetic resonance venography (40%); studies with the highest specificity were formal angiography (0.82), CT angiography (0.67), and CT venography (0.67). A diagnostic algorithm is proposed. CONCLUSIONS: Reaching a diagnosis in patients with PT requires a systematic approach, taking into account both clinical and radiographic information. Physical examination is a key first step for differentiating patients into venous, arterial, and other cohorts to narrow down the likely pathology and determine which radiographic studies have the highest yield and accuracy.

Vocal error monitoring in the primate auditory cortex

bioRxiv (Cold Spring Harbor Laboratory) · 2024-06-16

Abstract Sensory-motor control requires the integration and monitoring of sensory feedback resulting from our behaviors. This self-monitoring is thought to result from comparisons between predictions of expected sensory consequences of action and the feedback actually received, resulting in activity that encodes feedback error. Although similar mechanisms have been proposed during speech and vocal production, including sensitivity to experimentally-perturbed auditory feedback, evidence for a vocal ‘error signal’ has been limited. Here, we recorded from the auditory cortex of vocalizing non-human primates, using real-time frequency shifts to introduce feedback errors of varying magnitude and direction. We found neural activity that scaled with the magnitude of feedback error in both directions, consistent with vocal error monitoring at both the individual unit and population levels. This feedback sensitivity was greater than that predicted based upon passive sensory responses and was more specific for units in the vocal frequency range. Similar patterns of sensitivity were seen in response to natural variations in produced vocal acoustics. These results provide evidence that the auditory cortex encodes the degree of vocal feedback error using both unit-level error calculations and changes in the population of neurons involved. These mechanisms may provide critical error information necessary for feedback-dependent vocal control.

Signal processing and stimulation potential within the ascending auditory pathway: a review

Frontiers in Neuroscience · 2023-11-03 · 2 citations

The human auditory system encodes sound with a high degree of temporal and spectral resolution. When hearing fails, existing neuroprosthetics such as cochlear implants may partially restore hearing through stimulation of auditory neurons at the level of the cochlea, though not without limitations inherent to electrical stimulation. Novel approaches to hearing restoration, such as optogenetics, offer the potential of improved performance. We review signal processing in the ascending auditory pathway and the current state of conventional and emerging neural stimulation strategies at various levels of the auditory system.

Meningitis Risk and Role of Prophylactic Antibiotics in Spontaneous Lateral Skull Base CSF Leaks

Annals of Otology Rhinology & Laryngology · 2023-05-28 · 8 citations

OBJECTIVE: To review the literature and our institutional experience regarding the risk of meningitis in patients with spontaneous lateral skull base cerebrospinal fluid (sCSF) leaks awaiting surgical repair, and the roles of antibiotic prophylaxis and pneumococcal vaccination, if known. METHODS: A retrospective chart review and systematic review of the literature was undertaken to identify the incidence of meningitis in patients with sCSF leaks awaiting surgical repair. Adults managed surgically for sCSF leaks at an academic tertiary care center over a 10-year period were included. Data was collected on receipt of prophylactic antibiotics and/or pneumococcal vaccines during the timeframe between diagnosis and surgical repair. RESULTS: Institutional review identified 87 patients who underwent surgical repair of spontaneous leaks, with a 0% incidence of meningitis over a median duration of 2 months while awaiting surgery (mean 5.5 months, range 0.5-118 months). Eighty-eight percent of patients did not receive prophylactic antibiotics. No studies in the published literature demonstrated the impact of prophylactic antibiotics or pneumococcal vaccine on meningitis risk. CONCLUSIONS: There appears to be a low risk of meningitis among patients with lateral skull base sCSF leaks awaiting surgery for short durations (≤2 months), even in the absence of prophylactic antibiotics. There is a substantial gap in the published literature assessing the risk of meningitis and roles of antibiotics and vaccination in this patient population, indicating the need for large-scale study to conclusively elucidate the nature of this risk.