Click-evoked responses from the cochlear nucleus: a study in human

Neural Adaptation at Stimulus Onset and Speed of Neural Processing as Critical Contributors to Speech Comprehension Independent of Hearing Threshold or Age

Background: It is assumed that speech comprehension deficits in background noise are caused by age-related or acquired hearing loss. Methods: We examined young, middle-aged, and older individuals with and without hearing threshold loss using pure-tone (PT) audiometry, short-pulsed distortion-product otoacoustic emissions (pDPOAEs), auditory brainstem responses (ABRs), auditory steady-state responses (ASSRs), speech comprehension (OLSA), and syllable discrimination in quiet and noise. Results: A noticeable decline of hearing sensitivity in extended high-frequency regions and its influence on low-frequency-induced ABRs was striking. When testing for differences in OLSA thresholds normalized for PT thresholds (PTTs), marked differences in speech comprehension ability exist not only in noise, but also in quiet, and they exist throughout the whole age range investigated. Listeners with poor speech comprehension in quiet exhibited a relatively lower pDPOAE and, thus, cochlear amplifier performance independent of PTT, smaller and delayed ABRs, and lower performance in vowel-phoneme discrimination below phase-locking limits (/o/-/u/). When OLSA was tested in noise, listeners with poor speech comprehension independent of PTT had larger pDPOAEs and, thus, cochlear amplifier performance, larger ASSR amplitudes, and higher uncomfortable loudness levels, all linked with lower performance of vowel-phoneme discrimination above the phase-locking limit (/i/-/y/). Conslusions: This study indicates that listening in noise in humans has a sizable disadvantage in envelope coding when basilar-membrane compression is compromised. Clearly, and in contrast to previous assumptions, both good and poor speech comprehension can exist independently of differences in PTTs and age, a phenomenon that urgently requires improved techniques to diagnose sound processing at stimulus onset in the clinical routine.

Auditory brainstem responses are resistant to pharmacological modulation in Sprague Dawley wild-type and Neurexin1α knockout rats

Sensory processing in the auditory brainstem can be studied with auditory brainstem responses (ABRs) across species. There is, however, a limited understanding of ABRs as tools to assess the effect of pharmacological interventions. Therefore, we set out to understand how pharmacological agents that target key transmitter systems of the auditory brainstem circuitry affect ABRs in rats. Given previous studies, demonstrating that Nrxn1α KO Sprague Dawley rats show substantial auditory processing deficits and altered sensitivity to GABAergic modulators, we used both Nrxn1α KO and wild-type littermates in our study. First, we probed how different commonly used anesthetics (isoflurane, ketamine/xylazine, medetomidine) affect ABRs. In the next step, we assessed the effects of different pharmacological compounds (diazepam, gaboxadol, retigabine, nicotine, baclofen, and bitopertin) either under isoflurane or medetomidine anesthesia. We found that under our experimental conditions, ABRs are largely unaffected by diverse pharmacological modulation. Significant modulation was observed with (i) nicotine, affecting the late ABRs components at 90 dB stimulus intensity under isoflurane anesthesia in both genotypes and (ii) retigabine, showing a slight decrease in late ABRs deflections at 80 dB stimulus intensity, mainly in isoflurane anesthetized Nrxn1α KO rats. Our study suggests that ABRs in anesthetized rats are resistant to a wide range of pharmacological modulators, which has important implications for the applicability of ABRs to study auditory brainstem physiology.

Preserved Auditory Steady State Response and Envelope-Following Response in Severe Brainstem Dysfunction Highlight the Need for Cross-Checking

OBJECTIVES

Commercially available auditory steady state response (ASSR) systems are widely used to obtain hearing thresholds in the pediatric population objectively. Children are often examined during natural or induced sleep so that the recorded ASSRs are of subcortical origin, the inferior colliculus being often designated as the main ASSR contributor in these conditions. This report presents data from a battery of auditory neurophysiological objective tests obtained in 3 cases of severe brainstem dysfunction in sleeping children. In addition to ASSRs, envelope-following response (EFR) recordings designed to distinguish peripheral (cochlear nerve) from central (brainstem) were recorded to document the effect of brainstem dysfunction on the two types of phase-locked responses.

DESIGN

Results obtained in the 3 children with severe brainstem dysfunctions were compared with those of age-matched controls. The cases were identified as posterior fossa tumor, undiagnosed (UD), and Pelizaeus-Merzbacher-Like Disease. The standard audiological objective tests comprised tympanograms, distortion product otoacoustic emissions, click-evoked auditory brainstem responses (ABRs), and ASSRs. EFRs were recorded using horizontal (EFR-H) and vertical (EFR-V) channels and a stimulus phase rotation technique allowing isolation of the EFR waveforms in the time domain to obtain direct latency measurements.

RESULTS

The brainstem dysfunctions of the 3 children were revealed as abnormal (weak, absent, or delayed) ABRs central waves with a normal wave I. In addition, they all presented a summating and cochlear microphonic potential in their ABRs, coupled with a normal wave I, which implies normal cochlear and cochlear nerve function. EFR-H and EFR-V waveforms were identified in the two cases in whom they were recorded. The EFR-Hs onset latencies, response durations, and phase-locking values did not differ from their respective age-matched control values, indicating normal cochlear nerve EFRs. In contrast, the EFR-V phase-locking value and onset latency varied from their control values. Both patients had abnormal but identifiable and significantly phase-locked brainstem EFRs, even in a case with severely distorted ABR central waves. ASSR objective audiograms were recorded in two cases. They showed normal or slightly elevated (explained by a slight transmission loss) thresholds that do not yield any clue about their brainstem dysfunction, revealing the method's lack of sensitivity to severe brainstem dysfunction.

CONCLUSIONS

The present study, performed on 3 sleeping children with severe brainstem dysfunction but normal cochlear responses (cochlear microphonic potential, summating potential, and ABR wave I), revealed the differential sensitivity of three auditory electrophysiological techniques. Estimated thresholds obtained by standard ASSR recordings (cases UD and Pelizaeus-Merzbacher-Like Disease) provided no clue to the brainstem dysfunction clearly revealed by the click-evoked ABR. EFR recordings (cases posterior fossa tumor and UD) showed preserved central responses with abnormal latencies and low phase-locking values, whereas the peripheral EFR attributed to the cochlear nerve was normal. The one case (UD) for which the three techniques could be performed confirms this sensitivity gradient, emphasizing the need for applying the Cross-Check Principle by avoiding resorting to ASSR recording alone. The entirely normal EFR-H recordings observed in two cases further strengthen the hypothesis of its cochlear nerve origin in sleeping children.

Differential cortical activation patterns: pioneering sub-classification of tinnitus with and without hyperacusis by combining audiometry, gamma oscillations, and hemodynamics

The ongoing controversies about the neural basis of tinnitus, whether linked with central neural gain or not, may hamper efforts to develop therapies. We asked to what extent measurable audiometric characteristics of tinnitus without (T) or with co-occurrence of hyperacusis (TH) are distinguishable on the level of cortical responses. To accomplish this, electroencephalography (EEG) and concurrent functional near-infrared spectroscopy (fNIRS) were measured while patients performed an attentionally demanding auditory discrimination task using stimuli within the individual tinnitus frequency (fTin) and a reference frequency (fRef). Resting-state-fMRI-based functional connectivity (rs-fMRI-bfc) in ascending auditory nuclei (AAN), the primary auditory cortex (AC-I), and four other regions relevant for directing attention or regulating distress in temporal, parietal, and prefrontal cortex was compiled and compared to EEG and concurrent fNIRS activity in the same brain areas. We observed no group differences in pure-tone audiometry (PTA) between 10 and 16 kHz. However, the PTA threshold around the tinnitus pitch was positively correlated with the self-rated tinnitus loudness and also correlated with distress in T-groups, while TH experienced their tinnitus loudness at minimal loudness levels already with maximal suffering scores. The T-group exhibited prolonged auditory brain stem (ABR) wave I latency and reduced ABR wave V amplitudes (indicating reduced neural synchrony in the brainstem), which were associated with lower rs-fMRI-bfc between AAN and the AC-I, as observed in previous studies. In T-subjects, these features were linked with elevated spontaneous and reduced evoked gamma oscillations and with reduced deoxygenated hemoglobin (deoxy-Hb) concentrations in response to stimulation with lower frequencies in temporal cortex (Brodmann area (BA) 41, 42, 22), implying less synchronous auditory responses during active auditory discrimination of reference frequencies. In contrast, in the TH-group gamma oscillations and hemodynamic responses in temporoparietal regions were reversed during active discrimination of tinnitus frequencies. Our findings suggest that T and TH differ in auditory discrimination and memory-dependent directed attention during active discrimination at either tinnitus or reference frequencies, offering a test paradigm that may allow for more precise sub-classification of tinnitus and future improved treatment approaches.

Subcortical neural generators of the envelope-following response in sleeping children: A transfer function analysis

Multiple auditory structures, from cochlea to cortex, phase-lock to the envelope of complex stimuli. The relative contributions of these structures to the human surface-recorded envelope-following response (EFR) are still uncertain. Identification of the active contributor(s) is complicated by the fact that even the simplest two-tone (f₁&f₂) stimulus, targeting its (f₂-f₁) envelope, evokes additional linear (f₁&f₂) and non-linear (2f₁-f₂) phase-locked components as well as a transient auditory brainstem response (ABR). Here, we took advantage of the generalized primary tone phase variation method to isolate each predictable component in the time domain, allowing direct measurements of onset latency, duration and phase discontinuity values from which the involved generators were inferred. Targeting several envelope frequencies (0.22-1 kHz), we derived the EFR transfer functions along a vertical vertex-to-neck and a horizontal earlobe-to-earlobe recording channels, yielding respectively EFR-V and EFR-H waveforms. Subjects (N= 30) were sleeping children with normal electrophysiological thresholds and normal oto-acoustic emissions. Both EFR-H and EFR-V phase-locking values (PLV) transfer functions had a low-pass profile, EFR-V showing a lower cut-off frequency than EFR-H. We also computed the frequency-latency relationships of both EFRs onset latencies. EFR-H data fitted a power-law function incorporating a frequency-dependent traveling wave delay and a fixed one amounting to 1.2 ms. The fitted function nicely fell within five published estimations of the latency-frequency function of the ABR wave-I, thus pointing to a cochlear nerve origin. The absence of phase discontinuity and overall response durations that were equal to that of the stimulus indicated no contribution from a later generator. The recording of an entirely similar EFR-H response in a patient who had severe brainstem encephalitis with a normal, isolated, ABR wave-I but complete absence of later waves, further substantiated a cochlear nerve origin. Modeling of the EFR-V latency-frequency functions indicated a fixed transport time of 2 ms with respect to EFR-H onset, suggesting a cochlear nucleus (CN) origin, here also, without indication for multiple generators. Other features of the EFR-V response pointing to the CN were, at least for the EFR frequency below the cut-off values of the transfer functions, higher PLVs coupled with increased harmonic distortion. Such a behavior has been described in the so-called highly-synchronized neurons of the ventral cochlear nucleus (VCN). The present study compellingly demonstrated the advantage of isolating the EFR in the temporal domain so as to extract detailed spectro-temporal parameters that, combined with orthogonal recording channels, shed new light on the involved neural generators.

Dynamic Changes of Functional Neuronal Activities Between the Auditory Pathway and Limbic Systems Contribute to Noise-Induced Tinnitus with a Normal Audiogram

Tinnitus is thought to be triggered by aberrant neural activity in the central auditory pathway and is often accompanied by comorbidities of emotional distress and anxiety, which imply maladaptive functional connectivity to limbic structures, such as the amygdala and hippocampus. Tinnitus patients with normal audiograms can also have accompanying anxiety and depression, clinically. To test the role of functional connectivity between the central auditory pathway and limbic structures in patients with tinnitus with normal audiograms, we developed a murine noise-induced tinnitus model with a temporary threshold shift (TTS). Tinnitus mice exhibited reduced auditory brainstem response wave I amplitude, and an enhanced wave IV amplitude and wave IV/I amplitude ratio, as compared with control and non-tinnitus mice. Resting-state functional magnetic resonance imaging (fMRI) was used to identify abnormal connectivity of the amygdala and hippocampus and to determine the relationship with tinnitus characteristics. We found increased fMRI responses with amplitude of low-frequency fluctuation (ALFF) in the auditory cortex and decreased ALFF in the amygdala and hippocampus at day 1, but decreased ALFF in the auditory cortex and increased ALFF in the amygdala at day 28 post-noise exposure in tinnitus mice. Decreased functional connectivity between auditory brain regions and limbic structures was demonstrated at day 28 in tinnitus mice. Therefore, aberrant neural activities in tinnitus mice with TTS involved not only the central auditory pathway, but also limbic structures, and there was maladaptive functional connectivity between the central auditory pathway and limbic structures, such as the amygdala and hippocampus.

Reduced sound-evoked and resting-state BOLD fMRI connectivity in tinnitus

The exact neurophysiological basis of chronic tinnitus, which affects 10-15% of the population, remains unknown and is controversial at many levels. It is an open question whether phantom sound perception results from increased central neural gain or not, a crucial question for any future therapeutic intervention strategies for tinnitus. We performed a comprehensive study of mild hearing-impaired participants with and without tinnitus, excluding participants with co-occurrences of hyperacusis. A right-hemisphere correlation between tinnitus loudness and auditory perceptual difficulty was observed in the tinnitus group, independent of differences in hearing thresholds. This correlation was linked to reduced and delayed sound-induced suprathreshold auditory brain responses (ABR wave V) in the tinnitus group, suggesting subsided rather than exaggerated central neural responsiveness. When anatomically predefined auditory regions of interest were analysed for altered sound-evoked BOLD fMRI activity, it became evident that subcortical and cortical auditory regions and regions involved in sound detection (posterior insula, hippocampus), responded with reduced BOLD activity in the tinnitus group, emphasizing reduced, rather than increased, central neural gain. Regarding previous findings of evoked BOLD activity being linked to positive connectivities at rest, we additionally analysed r-fcMRI responses in anatomically predefined auditory regions and regions associated with sound detection. A profound reduction in positive interhemispheric connections of homologous auditory brain regions and a decline in the positive connectivities between lower auditory brainstem regions and regions involved in sound detection (hippocampus, posterior insula) were observed in the tinnitus group. The finding went hand-in-hand with the emotional (amygdala, anterior insula) and temporofrontal/stress-regulating regions (prefrontal cortex, inferior frontal gyrus) that were no longer positively connected with auditory cortex regions in the tinnitus group but were instead positively connected to lower-level auditory brainstem regions. Delayed sound processing, reduced sound-evoked BOLD fMRI activity and altered r-fcMRI in the auditory midbrain correlated in the tinnitus group and showed right hemisphere dominance as did tinnitus loudness and perceptual difficulty. The findings suggest that reduced central neural gain in the auditory stream may lead to phantom perception through a failure to energize attentional/stress-regulating networks for contextualization of auditory-specific information. Reduced auditory-specific information flow in tinnitus has until now escaped detection in humans, as low-level auditory brain regions were previously omitted from neuroimaging studies.

TRIAL REGISTRATION

German Clinical Trials Register DRKS0006332.

Processing Complex Sounds Passing through the Rostral Brainstem: The New Early Filter Model

The rostral brainstem receives both “bottom-up” input from the ascending auditory system and “top-down” descending corticofugal connections. Speech information passing through the inferior colliculus of elderly listeners reflects the periodicity envelope of a speech syllable. This information arguably also reflects a composite of temporal-fine-structure (TFS) information from the higher frequency vowel harmonics of that repeated syllable. The amplitude of those higher frequency harmonics, bearing even higher frequency TFS information, correlates positively with the word recognition ability of elderly listeners under reverberatory conditions. Also relevant is that working memory capacity (WMC), which is subject to age-related decline, constrains the processing of sounds at the level of the brainstem. Turning to the effects of a visually presented sensory or memory load on auditory processes, there is a load-dependent reduction of that processing, as manifest in the auditory brainstem responses (ABR) evoked by to-be-ignored clicks. Wave V decreases in amplitude with increases in the visually presented memory load. A visually presented sensory load also produces a load-dependent reduction of a slightly different sort: The sensory load of visually presented information limits the disruptive effects of background sound upon working memory performance. A new early filter model is thus advanced whereby systems within the frontal lobe (affected by sensory or memory load) cholinergically influence top-down corticofugal connections. Those corticofugal connections constrain the processing of complex sounds such as speech at the level of the brainstem. Selective attention thereby limits the distracting effects of background sound entering the higher auditory system via the inferior colliculus. Processing TFS in the brainstem relates to perception of speech under adverse conditions. Attentional selectivity is crucial when the signal heard is degraded or masked: e.g., speech in noise, speech in reverberatory environments. The assumptions of a new early filter model are consistent with these findings: A subcortical early filter, with a predictive selectivity based on acoustical (linguistic) context and foreknowledge, is under cholinergic top-down control. A prefrontal capacity limitation constrains this top-down control as is guided by the cholinergic processing of contextual information in working memory.

Differential Group Delay of the Frequency Following Response Measured Vertically and Horizontally

The frequency following response (FFR) arises from the sustained neural activity of a population of neurons that are phase locked to periodic acoustic stimuli. Determining the source of the FFR noninvasively may be useful for understanding the function of phase locking in the auditory pathway to the temporal envelope and fine structure of sounds. The current study compared the FFR recorded with a horizontally aligned (mastoid-to-mastoid) electrode montage and a vertically aligned (forehead-to-neck) electrode montage. Unlike previous studies, envelope and fine structure latencies were derived simultaneously from the same narrowband stimuli to minimize differences in cochlear delay. Stimuli were five amplitude-modulated tones centered at 576 Hz, each with a different modulation rate, resulting in different side-band frequencies across stimulus conditions. Changes in response phase across modulation frequency and side-band frequency (group delay) were used to determine the latency of the FFR reflecting phase locking to the envelope and temporal fine structure, respectively. For the FFR reflecting phase locking to the temporal fine structure, the horizontal montage had a shorter group delay than the vertical montage, suggesting an earlier generation source within the auditory pathway. For the FFR reflecting phase locking to the envelope, group delay was longer than that for the fine structure FFR, and no significant difference in group delay was found between montages. However, it is possible that multiple sources of FFR (including the cochlear microphonic) were recorded by each montage, complicating interpretations of the group delay.

Rhesus macaque model of chronic opiate dependence and neuro-AIDS: longitudinal assessment of auditory brainstem responses and visual evoked potentials

Our work characterizes the effects of opiate (morphine) dependence on auditory brainstem and visual evoked responses in a rhesus macaque model of neuro-AIDS utilizing a chronic continuous drug delivery paradigm. The goal of this study was to clarify whether morphine is protective, or if it exacerbates simian immunodeficiency virus (SIV)-related systemic and neurological disease. Our model employs a macrophage tropic CD4/CCR5 coreceptor virus, SIV(mac)239 (R71/E17), which crosses the blood-brain barrier shortly after inoculation and closely mimics the natural disease course of human immunodeficiency virus infection. The cohort was divided into three groups: morphine only, SIV only, and SIV + morphine. Evoked potential (EP) abnormalities in subclinically infected macaques were evident as early as 8 weeks postinoculation. Prolongations in EP latencies were observed in SIV-infected macaques across all modalities. Animals with the highest cerebrospinal fluid viral loads and clinical disease showed more abnormalities than those with subclinical disease, confirming our previous work (Raymond et al., J Neurovirol 4:512-520, 1998; J Neurovirol 5:217-231, 1999; AIDS Res Hum Retroviruses 16:1163-1173, 2000). Although some differences were observed in auditory and visual evoked potentials in morphine-treated compared to morphine-untreated SIV-infected animals, the effects were relatively small and not consistent across evoked potential type. However, morphine-treated animals with subclinical disease had a clear tendency toward higher virus loads in peripheral and central nervous system tissues (Marcario et al., J Neuroimmune Pharmacol 3:12-25, 2008) suggesting that if had been possible to follow all animals to end-stage disease, a clearer pattern of evoked potential abnormality might have emerged.

Reorganization of the adult auditory system: perceptual and physiological evidence from monaural fitting of hearing aids

Changes in the sensory environment modify our sensory experience and may result in experience-related or learning-induced reorganization within the central nervous system. Hearing aids change the sensory environment by stimulating a deprived auditory system; therefore, they may be capable of inducing changes within the central auditory system. Examples of studies that have shown hearing aid induced perceptual and/or physiological changes in the adult human auditory system are discussed. Evidence in the perceptual domain is provided by studies that have investigated (a) speech perception, (b) intensity discrimination, and (c) loudness perception. Evidence in the physiological domain is provided by studies that have investigated acoustic reflex thresholds and event-related potentials. Despite the controversy in the literature concerning the rate, extent, and clinical significance of the acclimatization effect, there is irrefutable evidence that the deprived auditory system of some listeners can be modified with hearing aid experience.

Reorganization of the adult auditory system: perceptual and physiological evidence from monaural fitting of hearing AIDS

Changes in the sensory environment modify our sensory experience and may result in experience-related or learning-induced reorganization within the central nervous system. Hearing aids change the sensory environment by stimulating a deprived auditory system; therefore, they may be capable of inducing changes within the central auditory system. Examples of studies that have shown hearing aid induced perceptual and/or physiological changes in the adult human auditory system are discussed. Evidence in the perceptual domain is provided by studies that have investigated (a) speech perception, (b) intensity discrimination, and (c) loudness perception. Evidence in the physiological domain is provided by studies that have investigated acoustic reflex thresholds and event-related potentials. Despite the controversy in the literature concerning the rate, extent, and clinical significance of the acclimatization effect, there is irrefutable evidence that the deprived auditory system of some listeners can be modified with hearing aid experience.

Asymmetry in the auditory brainstem response following experience of monaural amplification

Hearing aids can induce perceptual changes in some elderly listeners and there is recent evidence that this might be associated with reorganization within the auditory system. We compared the click-evoked auditory brainstem response in adults with and without monaural hearing aid experience. In listeners with monaural hearing aid experience, the mean peak-to-peak amplitude between wave V and SN10 was approximately 100 nV larger in the ear with hearing aid experience and this difference was statistically significant (P<0.01). The response was symmetrical in adults with no hearing aid experience. This suggests that hearing aids can induce physiological changes at the level of the auditory brainstem in elderly monaural hearing aid users.

Effect of caffeine on central auditory pathways: An evoked potential study

Caffeine is consumed in various forms like tea, coffee, chocolates and colas. The present study evaluated the effect of caffeine on auditory brainstem response (ABR), mid latency response (MLR) and slow vertex response (SVR) in 40 male volunteers. The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. The subjects consumed 3mg/kg body weight of caffeine after 12h abstinence from caffeine in any form. The data obtained revealed that latencies of waves IV and V along with I-V interpeak interval of ABR decreased significantly. This was accompanied with significant increase in amplitude of wave V. MLR latencies and latency of P1 wave of SVR was significantly decreased following caffeine ingestion. The results indicated that caffeine improves transmission in the peripheral and central brain auditory pathways.

Neural correlates of the precedence effect in auditory evoked potentials

The precedence effect in subjective localization tasks reflects the dominance of directional information of a direct sound (lead) over the information provided by one or several reflections (lags) for short delays. By collecting data of both psychoacoustical measurements and auditory evoked potentials the current study aims at neurophysiological correlates for the precedence effect in humans. In order to investigate whether the stimulus features or the perception of the stimulus is reflected on the ascending stages of the human auditory pathway, auditory brainstem responses (ABRs) as well as cortical auditory evoked potentials (CAEPs) using double click-pairs were recorded. Potentials were related to the results of the psychoacoustical data. ABRs to double click-pairs with lead-lag delays from 0 to 20 ms and interaural time differences (ITDs) in the lag click of 0 and 300 micros show an emerging second wave V for lead-lag delays larger than 2 ms. The amplitudes of the first and second wave V are the same for a lead-lag delay of about 5 ms. For the lag-ITD stimuli the latency of the second wave V was prolonged by approximately ITD/2 compared to the stimuli without lag-ITD. As the amplitudes of the second wave V were not decreased for a lead-lag delay around 5 ms as could be expected from psychoacoustical measurements of the precedence effect, ABRs reflect stimulus features rather than the perceptive qualities of the stimulus. The mismatch negativity (MMN) component of the CAEP for double click-pairs was determined using a diotic standard and a deviant with an ITD of 800 micros in the lag click. The comparison between the MMN components and the psychoacoustical data shows that the MMN is related to the perception of the stimulus, i.e., to the precedence effect. Generally, the findings of the present study suggest that the precedence effect is not a result of a poor sensitivity of the peripheral bottom-up processing. Rather, the precedence effect seems to be reflected by the MMN, i.e., cognitive processes on higher stages of the auditory pathway.

Brainstem correlates of defensive states in humans

BACKGROUND

Brainstem auditory evoked potentials (BAEP) reflect the activation of brainstem nuclei in the first milliseconds after presentation of an auditory stimulus. These electrophysiological correlates of neural processing are highly automatic and not influenced by cognitive factors or task demands; however, data from patients with anxiety disorders suggest deviations in the BAEP. It has been hypothesized that these differences reflect heightened activation of structures involved in defensive states, such as the amygdala and locus coeruleus, projecting to the inferior colliculus, one of the brainstem generators of wave V of the BAEP. The present study investigated this possibility by testing BAEP during experimentally induced anxiety in healthy volunteers.

METHODS

In this study, BAEP were recorded from healthy normal volunteers under threat of shock, compared with safe conditions.

RESULTS

The first experiment (n = 12) showed that shock anticipation increased the amplitude of wave V. A replication experiment (n = 13) confirmed this finding.

CONCLUSIONS

Although BAEP are highly robust with respect to attentional manipulations, they are affected by transient activation of the fear system due to threat of shock. This finding indicates that some of the electrophysiological brainstem abnormalities observed in anxiety disorders can be replicated in healthy control subjects by inducing a transient state of anxiety.

Intraoperative Monitoring of Cochlear Function Using Distortion Product Otoacoustic Emissions (DPOAEs) in Patients with Cerebellopontine Angle Tumors

HYPOTHESIS

Intraoperative monitoring by distortion-product otoacoustic emissions reflects the cochlear function changes in the real-time domain during removal of cerebellopontine angle tumors.

BACKGROUND

Cerebellopontine angle tumor surgery is associated with a significant risk of damaging internal auditory canal contents. Although monitoring facial nerve function intraoperatively has already been effectively developed, such efficacious monitoring of auditory function remains to be established. The aim of this study was to investigate the utility of distortion-product otoacoustic emissions for intraoperative monitoring of the cochlear function in humans during removal of cerebellopontine angle tumors.

METHODS

Continuous intraoperative monitoring of distortion-product otoacoustic emissions was performed in 20 of 62 patients undergoing surgical removal of cerebellopontine angle tumors. All of these 20 patients, who underwent the retrosigmoid approach, had distortion-product otoacoustic emissions present preoperatively. Depending on the amplitude and frequency band at which distortion-product otoacoustic emissions were present, monitoring was carried out at 2.0 to 6.0 kHz with primary stimulus tone amplitudes of 60 to 70 dB sound pressure level.

RESULTS

In patients operated on for cerebellopontine angle tumors, various patterns of distortion-product otoacoustic emission amplitude reductions and recoveries were observed. Distortion-product otoacoustic emissions recorded from the basal part of the cochlea (i.e., high frequencies) changed earlier and more profoundly than those from the middle and apical sections (i.e., lower frequencies). In some cases, cochlear function was affected irreversibly as reflected by loss of distortion-product otoacoustic emissions. Microcoagulation of small vessels, tumor debulking, and compression or stretch of the internal auditory canal contents were found to be procedures affecting distortion-product otoacoustic emissions. The status of distortion-product otoacoustic emissions at the conclusion of tumor dissection correlated with postoperative hearing levels.

CONCLUSION

Distortion-product otoacoustic emissions were used to monitor in the real-time domain auditory function during cerebellopontine angle tumor removal operations. The status of distortion-product otoacoustic emissions at the conclusion of the operations was related to postoperative hearing.

Activating separate ascending auditory pathways produces different human thalamic/cortical responses

When auditory nerve function is lost due to surgical removal of bilateral acoustic tumors in cases of neurofibromatosis type 2, a sense of hearing may be restored by means of an auditory brainstem implant (ABI), which electrically stimulates the cochlear nucleus. Electrically evoked auditory brainstem responses recorded from ABI subjects exhibit a variety of waveforms due to the presence or absence of different components. Evidently, ABI stimulation activates different ascending auditory pathways in different individuals. This study examined whether such differences at the brainstem level are associated with corresponding differences at higher levels. Multichannel recordings of electrically evoked middle-latency and late auditory responses were obtained from two ABI subjects whose very different electrically evoked auditory brainstem responses represent distinct categories of waveform morphology. The waveforms of both types of response were qualitatively similar in that for each condition tested there were corresponding main peaks and troughs. Quantitatively, however, there were differences in the scalp distributions and magnitudes of all components present. One subject had distributions suggesting bilateral activation and an N1-P2 complex of large amplitude, whereas the other subject had distributions suggesting unilateral activation contralateral to the side of stimulation and an N1-P2 complex of small amplitude. The differences suggest that activation of different ascending pathways in the auditory system results in different spatial and temporal patterns of neural activity in the thalamic and/or cortical auditory areas.

Evidence for efferent effects on early components of the human auditory brain-stem evoked potentials

OBJECTIVES AND METHODS

Auditory brain-stem evoked potentials (ABEPs) were recorded from 10 normal hearing subjects in response to rarefaction clicks, presented at a rate of 11/s. Stimuli were binaurally symmetrical and isochronic at 75 dB peSPL or with interaural time disparities (ITDs) of +/-0.4 ms, or intensity disparities (IIDs) of +/-10 dB. Potentials were recorded from vertex-neck, as well as from 3 orthonormally positioned differential derivations. The amplified potentials were averaged over 8000 repetitions using a dwell time of 20 micros/address/channel. The effects of contralateral stimulation on neural responses of the peripheral auditory system were obtained by subtracting the binaural response from the algebraic sum of responses to left and right monaural stimuli. From the 3 orthonormal derivations, 3-channel Lissajous' trajectories (3-CLTs) to the various stimulus conditions and difference waveforms were derived.

RESULTS

The results corroborated earlier studies on binaural interaction components (BICs), which include 3 major components corresponding in latency to the vertex-mastoid peaks IV-VI of ABEP. In addition, the binaural difference waveforms included 3 earlier, low-amplitude components. Latency correspondence and comparison of difference waveform and ABEP 3-CLTs indicated that the first and third early difference waveform components corresponded to the negative peaks following I and III, respectively, of the vertex-neck ABEP to binaural clicks.

CONCLUSIONS

These results indicate that early ABEP peaks, generated peripheral to binaural convergence, may be affected by contralateral stimulation. These contralateral effects were in a pattern compatible with suppression. most probably by efferents of the olivo-cochlear bundle.

Refractory properties of auditory brain-stem responses evoked by electrical stimulation of human cochlear nucleus: evidence of neural generators

In this study of electrically-evoked auditory brain-stem responses (EABRs) elicited by cochlear nucleus stimulation, 3 waves were identified after the initial wave that is directly initiated by the electric stimulus. Varying the rate of periodic stimulation or the interval between pairs of stimuli revealed that the shorter the latency of a wave, the faster it recovered from activation (i.e. shorter refractory period). The slow recovery of the third wave and an accompanying contribution to the second wave could be accounted for by postsynaptic generation in the two medial superior olivary nuclei (MSO); the faster recovery of another contribution to the second wave by generation in an axonal tract bending around the contralateral MSO; and the fastest recovery of the first wave by another axonal pathway having larger axons. Comparison with the relative latencies and spatial distribution of an acoustically-evoked auditory brain-stem response (AABR) indicated that the third wave corresponds to wave V, the second to wave IV (called IVb), and the first to a wave that precedes wave IV (called IVa). The anatomical interpretations for the two later waves of the EABR are consistent with most of the extant data on the neural generators of AABR waves IV and V. Thus, the present data and analysis strengthen the identification of the electrically evoked responses as EABRs and provide a firmer foundation for intra-operative EABR monitoring to assist auditory brain-stem implant placement.

ECochG, CNAP and ABR monitoring during vestibular Schwannoma surgery

Identification of the specific pathophysiological processes and correlation with post-operative hearing are the prerequisites for utilizing electrophysiological audio monitoring techniques in preventing damage to auditory structures during vestibular Schwannoma (VS) surgery. The present paper compares the value of auditory brainstem responses (ABRs), electrocochleography (ECochG) and directly recorded cochlear nerve action potentials (CNAPs) in detecting damage to auditory structures during VS surgery and predicting post-operative hearing. Eighteen consecutive patients operated on for VS, in an attempt at hearing preservation, participated in the investigation. The ipsilateral hearing level (pure tone average [PTA] 0.5-3 kHz) ranged from 10 to 50 dB HL (mean: 30.7 dB HL), with a speech discrimination score equal to or better than 50 per cent. CNAPs furnished the highest predictive score for post-operative hearing. In particular, when a permanent loss of CNAPs occurred the sensitivity and specificity were 100 per cent. The discrepancies between the ECochG and CNAP findings were attributable to high prevalence of cochlear nerve damage, capable of 'disconnecting' the ear from the central auditory pathways, causing persistence of peripheral auditory function and no propagation of the neural input. ABR monitoring was highly sensitive in detecting auditory damage but its prognostic utility was marred by its poor specificity.

Direct brainstem recording of auditory evoked potentials during vestibular schwannoma resection: nuclear BAEP recording. Technical note and preliminary results

The usefulness of intraoperative monitoring in cerebellopontine angle surgery should be improved by obtaining faster and stronger brainstem auditory evoked potential (BAEP) responses. A new technique of direct recording at the brainstem has been developed, which is applicable to all tumor sizes. By placing a retractor with electrodes attached to its tip at the cerebellomedullary junction, the authors have recorded BAEP amplitudes that are 10 times greater than those recorded using the conventional technique. Only small sampling numbers (64-256 recordings) are required and are obtained in 5 to 15 seconds. The technique has been applied successfully in 34 patients who underwent vestibular schwannoma resections. It has also been tested in patients with intrameatal-extrameatal meningiomas and in those with vascular compressive disorders; there have been no false results. The advantages of this new technique are: 1) identification of BAEP components is easier and faster; 2) reliable BAEP responses are obtained in some cases in which conventional BAEP responses are lost or severely deformed; and 3) BAEP response deterioration and improvement are recognized earlier than would occur using the conventional technique. This last advantage provides the surgeon with a useful warning at a stage of surgery at which BAEP changes are still temporary and can be reversed. This method is different from other trials of intradural BAEP recordings in three respects: its use is not limited to particular tumor sizes; there is no interference with the surgical process; and, most important, the obtained responses correlate well with those of conventional BAEP responses, probably because the recording site is in the vicinity of the anterior cochlear nucleus. In conclusion, the chances of useful monitoring feedback with adequate adaptation of the microsurgical strategy are improved considerably.

Long-term effect of perinatal and postnatal asphyxia on developing human auditory brainstem responses: brainstem impairment

Long-term effect of perinatal and postnatal asphyxia on the developing auditory brainstem was investigated in children, particularly those who exhibited residual neurodevelopmental deficits, by analyzing the central components of brainstem auditory evoked responses (BAER). The major abnormalities in the BAER were a reduction of wave V amplitude, followed by a decrease in V/I amplitude ratio, while abnormalities in interpeak intervals were relatively rare. These findings suggest that asphyxia could result in residual neural dysfunction of the brainstem but does not appear to exert any major long-term effect on neuronal transmission. BAER abnormalities occurred more frequently in the children with residual neurodevelopmental deficits than those without these deficits after perinatal asphyxia. The occurrence of BAER abnormalities was related to the duration as well as the degree of asphyxia. No significant difference was found in the abnormalities of the central BAER components between the children after perinatal asphyxia and those after postnatal asphyxia, suggesting that perinatal and postnatal asphyxia exerts a similar long-term effect on the developing central nervous system.

Auditory brain-stem responses evoked by electrical stimulation of the cochlear nucleus in human subjects

When auditory nerve function is lost due to surgical removal of bilateral acoustic tumors, a sense of hearing may be restored by means of an auditory brain-stem implant (ABI), which electrically stimulates the auditory pathway at the level of the cochlear nucleus. Placement of the stimulating electrodes during surgical implantation may be aided by electrically evoked auditory brain-stem responses (EABRs) recorded intra-operatively. To establish preliminary standards for human EABRs evoked by electrical stimulation of the cochlear nucleus, short-latency evoked potentials were recorded from 6 ABI patients who were either already implanted or undergoing implantation surgery. Neural responses were distinguished from stimulus artifact and equipment artifact by their properties during stimulus polarity reversal and amplitude variation. Other properties contributed to further identification of the evoked potentials as auditory responses (EABRs). The response waveforms generally had 2 or 3 waves. The peak latencies of these waves (approximately 0.3, 1.3, and 2.2 msec) and the brain-stem localization of the region from which they could be elicited are consistent with auditory brain-stem origin.

Microsurgical anatomy around the foramen of Luschka in relation to intraoperative recording of auditory evoked potentials from the cochlear nuclei

Three cadaveric heads were dissected to investigate the microsurgical anatomy around the foramen of Luschka. It was found possible to place a recording electrode in proximity to the cochlear nuclei by inserting it in the lateral recess of the fourth ventricle through the foramen of Luschka. In operations of the cerebellopontine angle using the retromastoid approach, access to the foramen of Luschka and the lateral recess is obtained by retracting the biventral lobule of the cerebellum in a caudal-rostral direction under a caudal-rostral/medial field of vision. The craniectomy might need to be enlarged a few millimeters in the caudal direction. A wick electrode can be inserted in the lateral recess beneath the choroid plexus in a rostromedial direction and to a depth of approximately 3 to 5 mm from the foramen of Luschka without excessive retraction of the cerebellum. The optimum position for the recording electrode is in the triangle formed by the axis of the cochlear nerve and the glossopharyngeal nerve and by the lip of the foramen of Luschka. The caudal retromastoid approach is more suitable than the translabyrinthine technique for recording from the cochlear nuclei as well as for implantation of stimulating electrodes into the cochlear nuclei for use as hearing prostheses.