International Journal of Head and Neck Surgery

Register      Login

VOLUME 12 , ISSUE 1 ( January-March, 2021 ) > List of Articles

Otology Research Article

Evaluation of Brain Activation (NeuroSPECT) by Uni- and Bilateral Auditory Stimulation in Patients with Conductive Hearing Loss and Bilateral Bone Conduction Devices

Marcos V Goycoolea, Sonia Neubauer, Raquel Levy, Jacqueline Cornejo, Byanka Cagnacci, Catherine Catenacci

Keywords : Adequate sound stimulation, Bilateral bone conduction devices, Bilateral conductive hearing loss, Binaural hearing, Early auditory stimulation, Language development, Real-life lateralization test, Sensory deprivation, Sound lateralization tests, Symmetric hearing, Timely stimulation

Citation Information : Goycoolea MV, Neubauer S, Levy R, Cornejo J, Cagnacci B, Catenacci C. Evaluation of Brain Activation (NeuroSPECT) by Uni- and Bilateral Auditory Stimulation in Patients with Conductive Hearing Loss and Bilateral Bone Conduction Devices. Int J Head Neck Surg 2021; 12 (1):22-30.

DOI: 10.5005/jp-journals-10001-1410

License: CC BY-NC 4.0

Published Online: 31-03-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: This prospective study evaluated sound localization and brain responses to monaural and binaural stimulation via bone conduction devices in 3 individuals with bilateral conductive hearing loss (1 acquired and 2 congenital). Aims and objectives: To determine the (1) Cortical areas that are activated with pure tones. (2) Potential benefits of bilateral devices. Materials and methods: A new audiological test is described (real-life lateralization test) and applied. NeuroSPECT studies were done using pure tones delivered via bone conduction devices (Baha Attract) stimulating monaurally and binaurally. The tests were performed 2–4 months after the placement of the second device. Results: The use of unilateral devices as well as bilateral devices under our testing conditions did not improve sound localization. There was improvement in lateralization with bilateral devices. In the three subjects, cortical activation with binaural auditory stimulation with the Baha Attract occurred in the same auditory areas compared with monaural stimulation. However, while in the individual with acquired loss, the degree of activation was less intense in binaural compared to monaural stimulation; in the congenital cases, binaural stimulation resulted in summation of stimuli. Conclusion: In congenital bilateral conductive hearing losses that have not been stimulated early, there are central auditory areas that are deprived. Even if these are only two cases, this is suggestive of the importance of bilateral early auditory stimulation in cases of congenital conductive hearing losses and supportive of the use of bilateral rather than unilateral devices.

  1. General Overview and Central transmission. Atlas of Otologic Surgery and Magic Otology Goycoolea M, ed., New Dehli, India: Jay Pee Brothers Medical Publishers; 2012. pp. 3–11.
  2. The inner ear and understanding the message (central processing). The Music of the Spheres and the Magic of Hearing Goycoolea M, ed., Ciudad de Panamá, Panamá: Jay Pee Highlights Medical Publishers; 2017. pp. 55–118.
  3. Sensing, perceiving and acting. The Brain O'Shea M, ed., Oxford, England: Oxford University Press; 2005. pp. 64–83.
  4. Hearing sound. Sound Goldsmith M, ed., Oxford England: Oxford University Press; 2015. pp. 52–68.
  5. Single-sided deafness and cochlear implantation in congenital and acquired hearing loss in children. Clin Otolaryngol 2018;44(2):138–143. DOI: 10.1111/coa.13245.
  6. Estimulación temprana y desarrollo lingüístico en niños sordos con implante coclear: el primer año de experiencia auditiva. Logopedia 2011;1:56–75.
  7. Bilateral cochlear implants should be the standard for children with bilateral sensorineural deafness. Curr Opinión Otolaryngol Head and Neck Surg 2008;16(1):69–74. DOI: 10.1097/MOO.0b013e3282f5e97c.
  8. Benefits of short interimplant delays in children receiving bilateral cochlear implants. Otol Neurotol 2009;30(3):319–331. DOI: 10.1097/MAO.0b013e31819a8f4c.
  9. Development of language and speech perception in congenitally profound deaf children as a function of age at cochlear implantation. Audiol Neurootol. 2004;9(4):224–233. DOI: 10.1159/000078392.
  10. Cortical plasticity and reorganization in pediatric singlelsided deafness pre and postcochlear implantation: a case study. Otol Neurotol 2016;37(2):26–34. DOI: 10.1097/MAO.0000000000000904.
  11. Functional studies of the human auditory pathway after monaural stimulation with pure tones. Establishing Nor Data Acta Oto-Laryng 2005;125(5):513–519. DOI: 10.1080/00016480510026250.
  12. Functional studies (NeuroSPECT) of the human auditory pathway after stimulating binaurally with pure tones. Acta Otolaryngol 2011;131(4):371–376. DOI: 10.3109/00016489.2010.545076.
  13. Bipolar affective disorders; assestment of functional brain changes by means of Tc99 HMPAO NeuroSPECT. Alasbimn J 2004. 6. Available from:,1206,SCID%253D6213,00.html.
  14. “Oh Granny, what big two ears you've got!” “All the better to hear you with, my dear!” (Neuronal Circuit recovery with a cochlear implant). This issue.
  15. Benefits and detriments of unilateral cochlear implant use on bilateral auditory development in children who are deaf. Front Psychol 2013. 1–24. DOI: 10.3389/fpsyg.2013.00719.
  16. Spoken language development in children following cochlear implantation. JAMA 2010;303(15):1498–1506. DOI: 10.1001/jama.2010.451.
  17. A sensitive period for the development of the central auditory system in children with cochlear implants: Implications for age of implantation. Ear Hear 2002;23(6):532–539. DOI: 10.1097/00003446-200212000-00004.
  18. Developmental neuroplasticity after cochlear implantation. Trends Neurosc 2012;35(2):111–122. DOI: 10.1016/j.tins.2011.09.004.
  19. Chances of reversibility in early sensory deprivation of the homo vulnerabilis: a 5 year (and ongoing) prospective study. Acta Otolaryngol 2019;139(4):357–360. DOI: 10.1080/00016489.2018.1538566.
  20. Results in cochlear implanted children before 5 years of age. A long term follow-up. Int J Pediat Otorhinolaryngol 2014;78(12):2183–2189. DOI: 10.1016/j.ijporl.2014.10.006.
  21. An exploratory look at pediatric cochlear implantation: is earliest always best? Ear Hear 2008;29(4):492–511. DOI: 10.1097/AUD.0b013e31816c409f.
  22. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics 2000;106(3):1–22. DOI: 10.1542/peds.106.3.e43.
  23. Cochlear implant use by prelingually deafened children: the influences of age at implant and length of device use. J Speech Lang Hear Res 1997;40(1):183–199. DOI: 10.1044/jslhr.4001.183.
  24. Speech, vocabulary, and the education of children using cochlear implants: oral or total communication? J Speech Lang Hear Res 2000;43(5):1185–1204. DOI: 10.1044/jslhr.4305.1185.
  25. Introduction and general perspective of sensorineural hearing loss. Rev Med Clin Condes 2016;27(6):721–730.
  26. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013;173(4):293–299. DOI: 10.1001/jamainternmed.2013.1868.
  27. Un nuevo factor de riesgo para demencia. Rev Otorrinolaringol Cir Cabeza Cuello 2017;77(3):237–238. DOI: 10.4067/s0718-48162017000300237.
  28. The development of language in genie: a case of language acquisition beyond the “critical period.”. Brain Language 1974;1(1):81–107. DOI: 10.1016/0093-934X(74)90027-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.