Speech-evoked cognitive P300 potentials in cochlear implant recipients

The cognitive P300 evoked potential was elicited by speech stimuli in successful cochlear implant recipients, and the resulting P300 morphology was remarkably similar to that of normal-hearing individuals. The P300 was elicited by the synthesized speech pair/da/and/di/ presented using an oddball paradigm to nine "good" Nucleus cochlear implant users and nine age-matched normal-hearing subjects (34-81 yr old). There were no significant differences in P300 amplitude and latency between the two groups. Moreover, the N1 and P2 potentials occurred at similar latencies in the two groups, although the N1 amplitude was significantly smaller in the cochlear implant users. The P300 was absent in one "poor" cochlear implant user. The results suggest that the P300 may serve as a useful tool for evaluating the cognitive aspects of auditory processing in cochlear implant recipients, and that it may aid in assessing the success of cochlear implantation.

Acoustic features and acoustic changes are represented by different central pathways

The central processing of acoustic stimulus changes can be observed neurophysiologically in the mismatch negativity auditory evoked potential (MMN). Stimuli differing in interaural phase were used to investigate the contributions of the primary and non-primary auditory pathways to the encoding of binaural stimuli and to investigate passively elicited measures of binaural processing in experimental animals. In guinea pigs, the MMN was obtained in response to 1000 Hz tones embedded in white noise (S:N = 2 dB). Using a modified oddball paradigm (that is, two stimuli presented in a series, each with a different probability of occurrence), stimuli were presented binaurally with both the tone and noise in-phase to the two ears (S0N0) as the standard stimulus ans the tone 180 degrees out-of-phase (S(PI)N0) as the deviant stimulus. The MMN, by definition, should occur only in response to a change, or 'mismatch,' between the standard and deviant stimuli. The response to the deviant stimulus in the oddball paradigm was compared to the response to the same stimulus when presented in a series alone. The responses to S0N0 and S(PI)N0 collected in a series alone, termed the intrinsic responses, were also compared. Responses were recorded from two surface epidural electrodes - one at the posterior midline and one over the left temporal lobe. AEPs from these locations have been shown to reflect the activity of primary and non-primary thalamo-cortical pathways respectively. A significant MMN was observed at the midline electrode, but no MMN was observed over the temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurophysiologic bases of speech discrimination

The mismatch negativity (MMN) is an automatic cortical evoked potential that signifies the brain's detection of acoustic change. In other words, the MMN reflects the neurophysiologic processes that underlie auditory discrimination. As such, the MMN provides an objective tool for evaluating central auditory mechanisms involved in speech perception. We are using the MMN to study the central auditory processes that encode acoustic changes important for speech perception in 1) normal-hearing adults and children, 2) individuals with impaired auditory systems (including persons with learning disabilities, attention deficit disorders, cochlear implants), and 3) an animal model. Specifically, we have demonstrated that the MMN provides information about the central processing of fine acoustic differences, the neuroanatomic pathways that encode acoustic change, central auditory processing in the presence of peripheral hearing deficits, and central auditory system plasticity. In addition, we have considered methodological challenges associated with measuring the MMN in individual subjects. Several methodological issues--including appropriate stimuli, stimulus presentation variables, the recording protocol and environment, and validation of the MMN in individuals--are discussed.

Discrimination of speech-like contrasts in the auditory thalamus and cortex

The neurophysiologic discrimination of acoustic contrasts was investigated as reflected by the mismatch negativity (MMN) response. Evoked responses were recorded from guinea pig thalamus (medial geniculate nucleus) and epidural surface in response to synthesized speech contrasts /ga/-/da/ and /ba/-/wa/. From the caudomedial portion of the medial geniculate nucleus, /ba/-/wa/ elicited a strong mismatch response, whereas /ga/-/da/ did not. Neither stimulus contrast elicited an MMN from the ventral, or primary, portion of medial geniculate. Both stimulus contrasts elicited an MMN from the midline surface. Neither contrast elicited an MMN from the surface over the temporal lobe. Results indicate a hierarchy of processing of the spectrotemporal changes which characterize formant transitions. Also, results indicate that the nonprimary portions of the auditory pathway contribute substantially to the MMN.

Nonprimary auditory thalamic representation of acoustic change

1. The mismatch response, or mismatch negativity (MMN), is a neurophysiologic response to stimulus change. In humans and other animals, the MMN may underlie the ability to discriminate acoustic differences, a fundamental aspect of auditory perception. 2. This study investigated the role of the thalamus in the generation of a tone-evoked MMN in guinea pigs. Electrodes were placed in the caudomedial (nonprimary) and ventral (primary) subdivisions of the auditory thalamus (medial geniculate nucleus). Surface epidural electrodes were placed at the midline and over the temporal lobe. The MMN was elicited by a deviant stimulus (2,450-Hz tone burst) embedded in a sequence of standard stimuli (2,300-Hz tone bursts). 3. A tone-evoked MMN was present in nonprimary thalamus but was absent in the primary thalamus. Surface-recorded MMNs were measured at the midline but not over the temporal lobe. The correspondence between nonprimary thalamic responses and midline surface potentials, and between primary thalamic responses and temporal surface potentials, is consistent with data reported for the auditory middle latency responses in guinea pigs. 4. The results demonstrate that the nonprimary auditory thalamus contributes to the generation of a tone-evoked MMN in the guinea pig. Furthermore, the data indicate that the guinea pig is a feasible model for investigating central auditory processes underlying acoustic discrimination.

Binaural response patterns in subdivisions of the medial geniculate body

Auditory evoked potentials (AEPs) to binaural click stimulation were examined in the ventral (MGv) and caudomedial (MGcm) subdivisions of the medial geniculate body (MG) in guinea pigs. Binaural stimulation caused a decrease in amplitude for the response component recorded from the MGv, but an increase in amplitude for the AEP component recorded from the MGcm. Findings suggest that the evoked responses recorded from MGv and MGcm are functionally distinct. The inhibitory binaural response (BR) pattern seen in MGv was similar to that of the middle latency response (MLR) component recorded over the temporal cortex, while the additive BR pattern typical of the MGcm was similar to that of the surface midline MLR component. Furthermore, these data imply that the binaural response patterns seen in the primary and non-primary auditory cortex may be processed and encoded at the thalamic level. It is concluded that the distinct BR patterns noted for the two MG subdivisions reflect the predominant type of binaurally responsive neurons within the respective pathways.

Mismatch negativity in the neurophysiologic/behavioral evaluation of auditory processing deficits: a case study

The subject of this case report is an 18-year-old woman with grossly abnormal auditory brain stem response (ABR), normal peripheral hearing, and specific behavioral auditory processing deficits. Auditory middle latency responses (MLRs) and cortical potentials N1, P2, and P300 were intact. The mismatch negativity (MMN) was normal in response to certain synthesized speech stimuli and impaired to others--consistent with her behavioral discrimination of these stimuli. Behavioral tests of auditory processing were consistent with auditory brain stem dysfunction. A neuropsychological evaluation revealed normal intellectual and academic performance. The subject was in her first year of college at the time of the evaluation. This case study is important because: (1) Although there have been several reports of absent/abnormal ABR with preserved peripheral hearing and deficits in auditory processing, little is known about the specific nature of the auditory deficits experienced by these individuals. Such information may be valuable to the clinical management of patients with this constellation of findings. (2) Of interest is the information that the mismatch negativity (MMN) cortical event-related potential can bring to the evaluation of patients with auditory processing deficits. The MMN reflects central auditory processing of small acoustic differences and may provide an objective measure of auditory discrimination. (3) From a theorectical standpoint, a patient with neural deficits affecting specific components of the auditory pathway provides insight into the relationship between evoked potentials and physiological mechanisms of auditory processing. How do various components of the auditory pathway contribute to speech discrimination? How might evoked potentials reflect the processes underlying the neural coding of specific features of speech stimuli such as timing and spectral cues?

Speech-evoked cortical potentials in children

Event-related potentials (ERPs) were obtained to synthesized speech stimuli in 16 school-aged children (7-11 years) and compared to responses in 10 adults. P1, N1, and P2 event-related potentials were elicited by the phoneme /ga/. The mismatch negativity (MMN) was elicited by variants of /da/ and /ga/, which differ in the onset frequency of the second and third formant transitions. In general, the well-defined N1/P2 complex characteristic of the adult response, was not found in children. Waves P1 and N1 had longer peak latencies in children than in adults. Wave P2 amplitude was smaller in children than in adults. In contrast to the often poorly delineated earlier cortical potentials, the MMN was well defined in children. Significant MMNs were obtained in all subjects tested. MMN magnitude (peak amplitude and area) was significantly larger in the children. No significant differences were found in peak latency and duration of the MMN in children compared to the adult response. Another negative wave occurring at 400 msec was also observed in response to the deviant stimuli. This negative wave occurred at a similar latency in adults and children and was significantly larger and more robust in children. Results support the view that development of ERPs does not involve a hierarchical process with respect to latency. That is, earlier occurring waves do not necessarily mature before later occurring waves. The latencies of P1, N1, and P2 and overall morphology of these waves may provide a measure of maturation of central pathways. The early development of the MMN, its apparent robustness in school-aged children, and its reflection of the processing of acoustic differences in speech stimuli suggest its possible use in the assessment of central auditory function.

Improving the reliability of the auditory middle latency response by monitoring EEG delta activity

The auditory middle latency response (MLR), a useful tool in the assessment of low-frequency auditory sensitivity, can be consistently recorded in young children during wakefulness, stages 1 and 2, and REM sleep. Responses are often absent or questionable during stage 4. An on-line measure indicating favorable periods for recording MLR during sleep is important for interpretation of absent potentials. Here, for children 5 to 7 years old, the reliability and detectability of MLR was compared to sleep state and the dominance of delta activity (0-3 Hz) in the EEG frequency spectrum. Dominance of delta activity, a characteristic of stage 4, was expressed in a "delta ratio," a measure of relative EEG energy in the 0 to 3 Hz frequency spectrum. A fixed delta ratio (DR = 9) allowed the differentiation of periods favorable for MLR. MLR wave Pa amplitude and latency also varied with delta ratio. Results indicate that on-line monitoring of the delta ratio will allow reliable testing of MLR in clinical situations.

Mismatch negativity in school-age children to speech stimuli that are just perceptibly different

The mismatch negativity event-related potential (MMN) was elicited in normal school-age children in response to just perceptibly different variants of the speech phoneme /da/. A significant MMN was measured in each subject tested. Child and adult MMNs were similar with respect to peak latency and duration. Measures of MMN magnitude (peak-to-peak amplitude and area) were significantly larger in children than in adults. The results of the present study indicate that the MMN can be elicited in response to minimal acoustic stimulus differences in complex speech signals in school-age children. The results support the feasibility of using the MMN as a tool in the study of deficient auditory perception in children.

Clinical implications of primary and nonprimary pathway contributions to the middle latency response generating system

Clinical use of the middle latency response (MLR) has been limited by the variability of the response during sleep in young children. Theoretically, this variability can be explained by the differential maturation of the primary and nonprimary components of the MLR generating system. The model is supported by animal neurophysiological data. Applied to the human system, the model predicts that, in children, MLR generators are active only during certain stages of sleep. From a clinical standpoint, this has led to a procedure for signaling the clinician when a child is in a sleep state favorable for recording the MLR.

The mismatch negativity cortical evoked potential elicited by speech in cochlear-implant users

The mismatch negativity (MMN) event-related potential is a non-task related neurophysiologic index of auditory discrimination. The MMN was elicited in eight cochlear implant recipients by the synthesized speech stimulus pair /da/ and /ta/. The response was remarkably similar to the MMN measured in normal-hearing individuals to the same stimuli. The results suggest that the central auditory system can process certain aspects of speech consistently, independent of whether the stimuli are processed through a normal cochlea or mediated by a cochlear prosthesis. The MMN shows promise as a measure for the objective evaluation of cochlear-implant function, and for the study of central neurophysiological processes underlying speech perception.

Acoustic versus phonetic representation of speech as reflected by the mismatch negativity event-related potential

The concept of categorical perception of speech and speech-like sounds has been central to models of speech perception for decades. Event-related potentials (ERPs) provide a neurophysiologic perspective of this important phenomenon. In the present experiment the mismatch negativity (MMN) event-related potential, which is sensitive to fine acoustic differences, was recorded in adults. Of interest was whether the MMN reflects the acoustic or categorical perception of speech. The MMN was elicited by stimulus pairs (along a continuum varying in place of articulation from /da/ to /ga/) which had been identified as the same phoneme /da/ (within category condition) and as different phonemes /da/ and /ga/ (across categories condition). The acoustic differences between these two pairs of stimuli were equivalent. The MMN was observed in all subjects both in the within and across category conditions. Furthermore, the MMN did not differ in latency, amplitude or area within and across categories. That is, the MMN indicated equal discrimination both across and within categories. These results suggest that the MMN appears to reflect the processing of acoustic aspects of the speech stimulus, but not phonetic processing into categories. The MMN appears to be an extremely sensitive electrophysiologic index of minimal acoustic differences in speech stimuli.

Reticular formation influences on primary and non-primary auditory pathways as reflected by the middle latency response

Ongoing studies are aimed at identifying the neural pathways responsible for the middle latency response (MLR). These studies involve the analysis of surface and intracranial potentials following pharmacologic inactivation (with lidocaine) of discrete regions of the guinea pig brain. Previous investigations have shown that MLR surface waves recorded over the temporal lobe originate from pathways anatomically and functionally distinct from those that generate MLR waves recorded over the midline, and that both primary and non-primary auditory thalamo-cortical pathways contribute to the guinea pig MLR. The present investigation examines the role of the mesencephalic reticular formation (mRF) in the MLR generating system. Inactivation of the mRF was associated with disruption of the midline response. These waves have been shown to reflect activity from non-primary subdivisions of the thalamo-cortical pathway. Components recorded over the temporal lobe were also affected, consisting of amplitude reduction and latency prolongation without changes in response morphology. Changes in temporal MLR components with mRF inactivation were smaller than those associated with direct inactivation of primary and non-primary subdivisions of the medial geniculate body. These findings indicate that mRF input is essential for normal generation of those components of the MLR thought to reflect both primary and non-primary auditory pathway activity.

Contributions of medial geniculate body subdivisions to the middle latency response

Ongoing studies in our laboratory, concerned with identifying the neural pathways responsible for the auditory middle latency response (MLR), have involved analysis of surface and intracranial potentials following pharmacologic inactivation (with lidocaine) of small regions in the guinea pig brain. Previous studies indicate that MLR surface waves recorded over the temporal lobe originate from pathways anatomically distinct from those that generate MLR waves recorded over the midline. The medial geniculate body (MG) contributes to both MLR responses. At issue here are the relative contributions of ventral and caudomedial subdivisions, which have been linked to primary and non-primary auditory pathways, respectively. Ventral and caudomedial subdivisions contributed to the surface-recorded MLR in a distinctive manner. Lidocaine injections to both areas reduced the amplitude of the surface temporal response. Caudomedial injections had a much greater effect on the surface midline responses than did injections in the ventral portion. Thus, the ventral division, a part of the primary auditory pathway, contributes chiefly to the temporal response. The caudomedial portion, which may be linked to non-primary auditory pathways, contributes to both responses.

Binaural stimulation reveals functional differences between midline and temporal components of the middle latency response in guinea pigs

Two morphologically distinct auditory middle latency response (MLR) wave forms can be recorded from the surface of the guinea pig brain. The temporal response is recorded from the temporal lobe contralateral to the stimulus ear, and the midline response is recorded over the posterior midline. Experimental evidence suggests that different neural generators contribute to the two responses. Furthermore, it appears that the temporal response principally reflects activity of the primary auditory pathway while the midline response reflects non-primary pathways. Although it is known that neurons throughout the auditory pathway exhibit distinct binaural interaction (BI) properties, thus far there have been no systematic attempts to differentiate the MLR wave forms in response to binaural stimulation. The purpose of this study was to determine if binaural click stimulation could functionally differentiate the midline and temporal MLR responses in the guinea pig. Binaural click stimulation caused a significant decrease in temporal MLR peak amplitudes, and a significant increase in midline MLR amplitudes. The fact that different BI patterns were observed suggests that the two MLR components are functionally distinct. The data further support the hypothesis that the midline and temporal MLR in guinea pigs reflect different neural generators and pathways.

Mismatch negativity event-related potential elicited by speech stimuli

The mismatch negativity (MMN) is a passively elicited event-related potential that is extremely sensitive to acoustic stimulus properties. The MMN was characterized in normal adults and school-age children in response to speech stimuli differing minimally in the onset frequency of the second and third formant transitions. The speech-evoked MMN consists of a negative waveform at about 230 msec that occurs in response to the deviant stimulus when it is presented in an oddball paradigm. It is absent in response to that same stimulus when presented alone. The MMN was clearly present in all adults and children tested. Using the procedures developed in this study, this event-related potential was found to be robust enough in individual subjects to be considered a potential clinical measure for assessing central auditory function in school-age children and adults.

Absence of sensorineural hearing loss in treated infants and children with congenital toxoplasmosis

Educationally significant hearing loss has been reported in 10% to 15% of children with congenital toxoplasmosis. As part of a pilot study to assess feasibility and safety of prolonged therapy for congenital toxoplasmosis, 30 congenitally infected infants and children were evaluated for auditory function. Serial testing, beginning within 2 months of birth, was performed. Availability of auditory brainstem response (ABR) testing made evaluation at an earlier age than previously possible. Six (20%) of the 30 infants had mild to moderate conductive type hearing loss associated with otitis media. No infant or child had sensorineural hearing loss. The better outcome we observed compared to previous reports of a 15% to 26% incidence of sensorineural hearing loss and 10% to 15% incidence of educationally significant, bilateral hearing impairment may be related to early initiation and/or prolonged institution of antimicrobial therapy. Continued followup to exclude progressive hearing impairment and study of larger numbers of children are needed to verify these preliminary findings.

Subcortical and cortical components of the MLR generating system

The contributions of the auditory thalamo-cortical pathway, mesencephalic reticular formation, and inferior colliculus to the surface recorded auditory middle latency response (MLR) were assessed by selective inactivation of these areas with lidocaine. Evoked responses were recorded simultaneously from these areas and from the cortical surface. Lidocaine-induced changes were compared across recording sites. In the guinea pig, surface components measured from over the temporal lobe (waves A, B and C) and the midline (waves M- and M+) have been previously shown to reflect the activity of two distinct generating mechanisms. Effects of lidocaine injections corresponded to selective changes in components from these two systems. Injections in the medial geniculate body (MGB) were associated with total disruption of surface potentials measured over the temporal lobe, auditory cortex (AC) responses, and local activity in MGB. Thus the thalamo-cortical pathway appears to be important for the generation of MLRs recorded from the surface of the temporal lobe. These injections generally did not alter the surface midline responses or activity obtained from either the mesencephalic reticular formation (mRF) or the inferior colliculus (IC). Lidocaine injections within AC did not alter the basic response morphology of surface potentials, nor were significant changes measured within AC. Lidocaine injections into the mRF produced changes in all surface temporal potentials, the M+ midline surface potential, and in local potentials recorded from MGB and mRF. Injections into the IC changed surface and subcortical responses at all sites. This was the only injection to affect activity at the latency of surface midline wave, M-1. This wave may be the animal analogue for human wave Na. Control experiments indicated that the effects observed were specific to the neural inactivation of target areas. The MLR generating system appears to consist of contributions and interactions from multiple areas including the auditory thalamo-cortical pathway, mRF and IC. The animal model and experimental strategy described appear promising for linking the contributions from specific brain areas to surface MLR waves.

Practicing nurse-midwifery in the medical-legal climate. Intrapartum issues

Clinical management in the intrapartum period is examined from a risk-management perspective. The need for current clinical protocols, obtaining medical consultation when necessary, and clear and complete charting is stressed.

Clinical applications of the middle latency response

The protocol developed in our laboratory for the assessment of hearing, involving the middle latency response (MLR), is described. Applications are illustrated in cases: (1) where the MLR was used to identify residual low frequency hearing and (2) where the MLR provided the only available threshold data because brainstem damage compromised the use of the ABR for hearing assessment. An understanding of the MLR generating system can provide insight into the mechanisms responsible for the inconsistency of the MLR in children. Animal models and human data indicate that maturation of the generating network may involve an early developing, variable system influenced by the mesencephalic reticular formation, and a later developing, stable system dominated by the thalamo-cortical pathway. If the thalamo-cortical system is not yet mature, one might expect the response to vary depending upon the subject's level of alertness. The observed MLR may then be dominated by other, sleep-dependent systems involving the reticular formation.