CC BY-NC-ND 4.0 · Semin Hear 2024; 45(01): 083-100
DOI: 10.1055/s-0043-1770139
Review Article

Clinical Gaps-in-Noise Measures in Blast-Exposed Veterans: Associations with Electrophysiological and Behavioral Responses

Melissa A. Papesh
1   VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
2   Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
Tess Koerner
1   VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
2   Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
› Author Affiliations
FUNDING/ACKNOWLEDGMENTS The authors would like to thank Dr. Robert L. Folmer for his study design recommendations, and Dr. Frederick J. Gallun for his development of the MATLAB version of GIN behavioral testing used in the present study. This work was supported by VA RR&D Career Development Awards #IK2RX002673 (PI: Papesh), #RX001820-01A1 (PI: Papesh), and #RX003187 (PI: Tess Koerner). This material is the result of work supported with resources and the use of facilities at the VA Rehabilitation Research and Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR; Center Award #C2361C/I50 RX002361) at the VA Portland Health Care System in Portland, Oregon.


It has been established that blast exposure and brain injury can result in self-reported and measured auditory processing deficits in individuals with normal or near-normal hearing sensitivity. However, the impaired sensory and/or cognitive mechanisms underlying these auditory difficulties are largely unknown. This work used a combination of behavioral and electrophysiological measures to explore how neural stimulus discrimination and processing speed contribute to impaired temporal processing in blast-exposed Veterans measured using the behavioral Gaps-in-Noise (GIN) Test. Results confirm previous findings that blast exposure can impact performance on the GIN and effect neural auditory discrimination, as measured using the P3 auditory event-related potential. Furthermore, analyses revealed correlations between GIN thresholds, P3 responses, and a measure of behavioral reaction time. Overall, this work illustrates that behavioral responses to the GIN are dependent on both auditory-specific bottom-up processing beginning with the neural activation of the cochlea and auditory brainstem as well as contributions from complex neural networks involved in processing speed and task-dependent target detection.

Publication History

Article published online:
23 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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