Binaural interaction in brainstem auditory evoked potentials elicited by frequency-specific stimuli

Reinterpreting the human ABR binaural interaction component: isolating attention from stimulus effects

Subtracting the sum of left and right monaural auditory brainstem responses (ABRs) from the corresponding binaural ABR isolates the binaural interaction component (ABR-BIC). In a previous investigation (Ikeda, 2015), during auditory yet not visual tasks, tone-pips elicited a significant difference in amplitude between summed monaural and binaural ABRs. With click stimulation, this amplitude difference was task-independent. This self-critical reanalysis's purpose was to establish that a difference waveform (i.e., ABR-BIC DN1) reflected an auditory selective attention effect that was isolable from stimulus factors. Regardless of whether stimuli were tone-pips or clicks, effect sizes of the DN1 peak amplitudes relative to zero improved during auditory tasks over visual tasks. Auditory selective attention effects on the monaural and binaural ABR wave-V amplitudes were tone-pip specific. Those wave-V effects thus could not explain the stimulus-universal effect of auditory selective attention on DN1 detectability, which was thus entirely binaural. In a manner isolated from auditory selective attention, multiple mediation analyses indicated that the higher right monaural wave-V amplitudes mediated individual differences in how clicks, relative to tone-pips, augmented DN1 amplitudes. There are implications of these findings for advancing ABR-BIC measurement.

Encoding of a binaural speech stimulus at the brainstem level in middle-aged adults

OBJECTIVE

Binaural hearing is facilitated by neural interactions in the auditory pathway. Ageing results in impairment of localisation and listening in noisy situations without any significant hearing loss. The present study focused on comparing the binaural encoding of a speech stimulus at the subcortical level in middle-aged versus younger adults, based on speech-evoked auditory brainstem responses.

METHODS

Thirty participants (15 young adults and 15 middle-aged adults) with normal hearing sensitivity (less than 15 dB HL) participated in the study. The speech-evoked auditory brainstem response was recorded monaurally and binaurally with a 40-ms /da/ stimulus. Fast Fourier transform analysis was utilised.

RESULTS

An independent sample t-test revealed a significant difference between the two groups in fundamental frequency (F0) amplitude recorded with binaural stimulation.

CONCLUSION

The present study suggested that ageing results in degradation of F0 encoding, which is essential for the perception of speech in noise.

Binaural interaction component of the auditory brainstem response in children with autism spectrum disorder

INTRODUCTION

There is ample evidence that auditory dysfunction is a common feature of autism spectrum disorder (ASD). Binaural interaction component (BIC) manifests binaural interaction and is valid and proven response which reflects ongoing binaural processing.

OBJECTIVES

To investigate the differences in binaural interaction component of auditory brainstem response (ABR-BIC) between children with autism spectrum disorder (ASD) and normal peers and to correlate between ABR-BIC amplitudes and the acquired communication skills in ASD children.

METHODS

ASD was diagnosed according to the criteria of 5th edition of diagnostic and statistical manual of mental disorders (DSM-V) and all children with ASD underwent test of acquired communication skills (TACS). Click evoked ABRs were elicited by left monaural, right monaural and binaural stimulation at intensity of 65 dBnHL in all participants. ABR-BIC was then calculated as the difference between the binaurally evoked ABR waveform and a predicted binaural waveform created by algebraically summing the left and right monaurally evoked ABRs. The difference in amplitudes that gives rise to ABR-BIC is at IV-VI waves.

RESULTS

ABR-BIC amplitudes were demonstrated to be significantly reduced in the ASD group compared to the control group. There was significant positive correlation between ABR-BIC amplitude and the language and social scores in TACS.

CONCLUSION

This study provided an objective evidence of binaural processing disorder in children with ASD.

Absence of Claudin 11 in CNS Myelin Perturbs Behavior and Neurotransmitter Levels in Mice

Neuronal origins of behavioral disorders have been examined for decades to construct frameworks for understanding psychiatric diseases and developing useful therapeutic strategies with clinical application. Despite abundant anecdotal evidence for white matter etiologies, including altered tractography in neuroimaging and diminished oligodendrocyte-specific gene expression in autopsy studies, mechanistic data demonstrating that dysfunctional myelin sheaths can cause behavioral deficits and perturb neurotransmitter biochemistry have not been forthcoming. At least in part, this impasse stems from difficulties in identifying model systems free of degenerative pathology to enable unambiguous assessment of neuron biology and behavior in a background of myelin dysfunction. Herein we examine myelin mutant mice lacking expression of the Claudin11 gene in oligodendrocytes and characterize two behavioral endophenotypes: perturbed auditory processing and reduced anxiety/avoidance. Importantly, these behaviors are associated with increased transmission time along myelinated fibers as well as glutamate and GABA neurotransmitter imbalances in auditory brainstem and amygdala, in the absence of neurodegeneration. Thus, our findings broaden the etiology of neuropsychiatric disease to include dysfunctional myelin, and identify a preclinical model for the development of novel disease-modifying therapies.

The Physiological Basis and Clinical Use of the Binaural Interaction Component of the Auditory Brainstem Response

The auditory brainstem response (ABR) is a sound-evoked noninvasively measured electrical potential representing the sum of neuronal activity in the auditory brainstem and midbrain. ABR peak amplitudes and latencies are widely used in human and animal auditory research and for clinical screening. The binaural interaction component (BIC) of the ABR stands for the difference between the sum of the monaural ABRs and the ABR obtained with binaural stimulation. The BIC comprises a series of distinct waves, the largest of which (DN1) has been used for evaluating binaural hearing in both normal hearing and hearing-impaired listeners. Based on data from animal and human studies, the authors discuss the possible anatomical and physiological bases of the BIC (DN1 in particular). The effects of electrode placement and stimulus characteristics on the binaurally evoked ABR are evaluated. The authors review how interaural time and intensity differences affect the BIC and, analyzing these dependencies, draw conclusion about the mechanism underlying the generation of the BIC. Finally, the utility of the BIC for clinical diagnoses are summarized.

Age-Related Changes in Binaural Interaction at Brainstem Level

OBJECTIVES

Age-related hearing loss hampers the ability to understand speech in adverse listening conditions. This is attributed to a complex interaction of changes in the peripheral and central auditory system. One aspect that may deteriorate across the lifespan is binaural interaction. The present study investigates binaural interaction at the level of the auditory brainstem. It is hypothesized that brainstem binaural interaction deteriorates with advancing age.

DESIGN

Forty-two subjects of various age participated in the study. Auditory brainstem responses (ABRs) were recorded using clicks and 500 Hz tone-bursts. ABRs were elicited by monaural right, monaural left, and binaural stimulation. Binaural interaction was investigated in two ways. First, grand averages of the binaural interaction component were computed for each age group. Second, wave V characteristics of the binaural ABR were compared with those of the summed left and right ABRs.

RESULTS

Binaural interaction in the click ABR was demonstrated by shorter latencies and smaller amplitudes in the binaural compared with the summed monaural responses. For 500 Hz tone-burst ABR, no latency differences were found. However, amplitudes were significantly smaller in the binaural than summed monaural condition. An age-effect was found for 500 Hz tone-burst, but not for click ABR.

CONCLUSIONS

Brainstem binaural interaction seems to decline with age. Interestingly, these changes seem to be stimulus-dependent.

Aging effects on the binaural interaction component of the auditory brainstem response in the Mongolian gerbil: Effects of interaural time and level differences

The effect of interaural time difference (ITD) and interaural level difference (ILD) on wave 4 of the binaural and summed monaural auditory brainstem responses (ABRs) as well as on the DN1 component of the binaural interaction component (BIC) of the ABR in young and old Mongolian gerbils (Meriones unguiculatus) was investigated. Measurements were made at a fixed sound pressure level (SPL) and a fixed level above visually detected ABR threshold to compensate for individual hearing threshold differences. In both stimulation modes (fixed SPL and fixed level above visually detected ABR threshold) an effect of ITD on the latency and the amplitude of wave 4 as well as of the BIC was observed. With increasing absolute ITD values BIC latencies were increased and amplitudes were decreased. ILD had a much smaller effect on these measures. Old animals showed a reduced amplitude of the DN1 component. This difference was due to a smaller wave 4 in the summed monaural ABRs of old animals compared to young animals whereas wave 4 in the binaural-evoked ABR showed no age-related difference. In old animals the small amplitude of the DN1 component was correlated with small binaural-evoked wave 1 and wave 3 amplitudes. This suggests that the reduced peripheral input affects central binaural processing which is reflected in the BIC.

A Comparison of Two Objective Measures of Binaural Processing: The Interaural Phase Modulation Following Response and the Binaural Interaction Component

There has been continued interest in clinical objective measures of binaural processing. One commonly proposed measure is the binaural interaction component (BIC), which is obtained typically by recording auditory brainstem responses (ABRs)—the BIC reflects the difference between the binaural ABR and the sum of the monaural ABRs (i.e., binaural − (left + right)). We have recently developed an alternative, direct measure of sensitivity to interaural time differences, namely, a following response to modulations in interaural phase difference (the interaural phase modulation following response; IPM-FR). To obtain this measure, an ongoing diotically amplitude-modulated signal is presented, and the interaural phase difference of the carrier is switched periodically at minima in the modulation cycle. Such periodic modulations to interaural phase difference can evoke a steady state following response. BIC and IPM-FR measurements were compared from 10 normal-hearing subjects using a 16-channel electroencephalographic system. Both ABRs and IPM-FRs were observed most clearly from similar electrode locations—differential recordings taken from electrodes near the ear (e.g., mastoid) in reference to a vertex electrode (Cz). Although all subjects displayed clear ABRs, the BIC was not reliably observed. In contrast, the IPM-FR typically elicited a robust and significant response. In addition, the IPM-FR measure required a considerably shorter recording session. As the IPM-FR magnitude varied with interaural phase difference modulation depth, it could potentially serve as a correlate of perceptual salience. Overall, the IPM-FR appears a more suitable clinical measure than the BIC.

Binaural interaction in human auditory brainstem response compared for tone-pips and rectangular clicks under conditions of auditory and visual attention

Binaural interaction in the auditory brainstem response (ABR) represents the discrepancy between the binaural waveform and the sum of monaural ones. A typical ABR binaural interaction in humans is a reduction of the binaural amplitude compared to the monaural sum at the wave-V latency, i.e., the DN1 component. It has been considered that the DN1 is mainly elicited by high frequency components of stimuli whereas some studies have shown the contribution of low-to-middle frequency components to the DN1. To examine this issue, the present study compared the ABR binaural interaction elicited by tone pips (1 kHz, 10-ms duration) with the one by clicks (a rectangular wave, 0.1-ms duration) presented at 80 dB peak equivalent SPL and a fixed stimulus onset interval (180 ms). The DN1 due to tone pips was vulnerable compared to the click-evoked DN1. The pip-evoked DN1 was significantly detected under auditory attention whereas it failed to reach significance under visual attention. The click-evoked DN1 was robustly present for the two attention conditions. The current results might confirm the high frequency sound contribution to the DN1 elicitation.

Frequency Dependence of Binaural Interaction in the Auditory Brainstem and Middle Latency Responses

Purpose

The primary purpose of this investigation was to determine the relative frequency representation of binaural function in the brainstem and cortex of adults. The secondary purpose was to compare adult responses to previously reported infant responses.

Methods

Simultaneous auditory brainstem responses and auditory middle responses were recorded monaurally and binaurally in 20 young women. The binaural (BIN) response was subtracted from the summed monaural waves (L+R) to obtain the binaural interaction components (BIC) from waves V (peak A) and Pa (BIC-Pa). Amplitude ratios were calculated as BIC/L+R. Repeated-measures analyses of variance evaluated responses to frequency (500 Hz vs. 4000 Hz), wave condition (L+R vs. BIN), and wave class (auditory brainstem response vs. auditory middle response).

Results

Waveforms were present for all conditions. The L+R responses were larger than the BIN responses, 500 Hz produced larger amplitudes than 4000 Hz, and Pa was larger than wave V. The largest response, overall, was the Pa(L+R) response to 500 Hz. For amplitude ratios, BIC-Pa/Pa(L+R) was larger than Peak A/[V(L+R)].

Conclusion

More neural resources are devoted to binaural function in the cortex than in the brainstem, and more resources are devoted to lower frequencies than to higher frequencies. The adult data confirm that previously recorded infant data reveal binaural immaturity. Longitudinal data should characterize developmental characteristics of binaural function.

Hyperthermia impaired pre-attentive processing: an auditory MMN study

This study investigated the effect of hyperthermia on pre-attentive processing by recording the mismatch negativity (MMN) component of ERPs. 36 right-handed young male undergraduates were divided into two groups, a control group with 1h of exposure at 25°C and a heat group with 1h of exposure at 50°C. MMNs were recorded before and after heat exposure. It was found that, although there was no group difference before heat exposure, MMN declined significantly in the heat group compared to the control group after heat exposure for 1h, indicating that passive heat exposure could damage pre-attentive processing. The MMN component could be a good index to assess cognitive functioning in a hot environment.

The influence of externalization and spatial cues on the generation of auditory brainstem responses and middle latency responses

The effect of externalization and spatial cues on the generation of auditory brainstem responses (ABRs) and middle latency responses (MLRs) was investigated in this study. Most previous evoked potential studies used click stimuli with variations of interaural time (ITDs) and interaural level differences (ILDs) which merely led to a lateralization of sound inside the subject's head. In contrast, in the present study potentials were elicited by a virtual acoustics stimulus paradigm with 'natural' spatial cues and compared to responses to a diotic, non-externalized reference stimulus. Spatial sound directions were situated on the horizontal plane (corresponding to variations in ITD, ILD, and spectral cues) or the midsagittal plane (variation of spectral cues only). An optimized chirp was used which had proven to be advantageous over the click since it compensates for basilar membrane dispersion. ABRs and MLRs were recorded from 32 scalp electrodes and both binaural potentials (B) and binaural difference potentials (BD, i.e., the difference between binaural and summed monaural responses) were investigated. The amplitudes of B and BD to spatial stimuli were not higher than those to the diotic reference. ABR amplitudes decreased and latencies increased with increasing laterality of the sound source. A rotating dipole source exhibited characteristic patterns in dependence on the stimulus laterality. For the MLR data, stimulus laterality was reflected in the latency of component N(a). In addition, dipole source analysis revealed a systematic magnitude increase for the dipole contralateral to the azimuthal position of the sound source. For the variation of elevation, the right dipole source showed a stronger activation for stimuli away from the horizontal plane. The results indicate that at the level of the brainstem and primary auditory cortex binaural interaction is mostly affected by interaural cues (ITD, ILD). Potentials evoked by stimuli with natural combinations of ITD, ILD, and spectral cues were not larger than those elicited by diotic chirps.

Interaural delay-dependent changes in the binaural difference potential of the human auditory brain stem response

Binaural difference potentials (BDs) are thought to be generated by neural units in the brain stem responding specifically to binaural stimulation. They are computed by subtracting the sum of monaural responses from the binaural response, BD = B - (L + R). BDs in dependency on the interaural time difference (ITD) have been measured and compared to the Jeffress model in a number of studies with conflicting results. The classical Jeffress model assuming binaural coincidence detector cells innervated by bilateral excitatory cells via two delay lines predicts a BD latency increase of ITD/2. A modification of the model using only a single delay line as found in birds yields a BD latency increase of ITD. The objective of this study is to measure BDs with a high signal-to-noise ratio for a large range of ITDs and to compare the data with the predictions of some models in the literature including that of Jeffress. Chirp evoked BDs were recorded for 17 ITDs in the range from 0 to 2 ms at a level of 40 dB nHL for four channels (A1, A2, PO9, PO10) from 11 normal hearing subjects. For each binaural condition 10,000 epochs were collected while 40,000 epochs were recorded for each of the two monaural conditions. Significant BD components are observed for ITDs up to 2 ms. The peak-to-peak amplitude of the first components of the BD, DP1-DN1, is monotonically decreasing with ITD. This is in contrast with click studies which reported a constant BD-amplitude for ITDs up to 1 ms. The latency of the BD-component DN1 is monotonically, but nonlinearly increasing with ITD. In the current study, DN1 latency is found to increase faster than ITD/2 but slower than ITD incompatible with either variant of the Jeffress model. To describe BD waveforms, the computational model proposed by Ungan et al. [Hearing Research 106, 66-82, 1997] using ipsilateral excitatory and contralateral inhibitory inputs to the binaural cells was implemented with only four parameters and successfully fitted to the BD data. Despite its simplicity the model predicts features which can be physiologically tested: the inhibitory input must arrive slightly before the excitatory input, and the duration of the inhibition must be considerably longer than the standard deviations of excitatory and inhibitory arrival times to the binaural cells. With these characteristics, the model can accurately describe BD amplitude and latency as a function of the ITD.

Interaural delay-dependent changes in the binaural interaction component of the guinea pig brainstem responses

Auditory brainstem responses to monaural and binaural clicks with 23 different interaural time differences (ITDs) were recorded from ten guinea pigs without anesthesia. Binaural interaction component was obtained by subtracting the sum of the appropriately time-shifted left and right monaural responses from the binaural one. With increasing ITD, the most prominent peak of the binaural difference potential so obtained shifted to longer latencies and its amplitude gradually decreased. The way these changes depended on binaural delay was basically similar to that previously observed in a cat study [P. Ungan, S. Yagcioglu, B. Ozmen. Interaural delay-dependent changes in the binaural difference potential in cat auditory brainstem response: implications about the origin of the binaural interaction component. Hear. Res. 106 (1997) 66-82]. The data were successfully simulated by the model suggested in that report. We therefore concluded that the same model, which was based on the difference between the mean onset latencies of the ipsilateral excitation and contralateral inhibition in a typical neuron in the lateral superior olive, their standard deviations, and the duration of the contralateral inhibition, should also be valid for the binaural interaction in the guinea pig brainstem. The results, which were discussed in connection with sound lateralization models, supported a model based on population coding, where the lateral position of a sound source is coded by the ratio of the discharge intensity in the left and right lateral superior olives, rather than the models based on coincidence detection.

Analysis and detection of binaural interaction in auditory evoked brainstem responses by time-scale representations

The beta-wave of the binaural interaction component (BIC) in auditory evoked brainstem responses has been shown to be an objective measure of binaural interaction. However, a reliable and automated detection of this component capable of clinical use still remains a challenge. In this study, wavelet based time-scale representations of auditory evoked brainstem responses were investigated for the analysis of binaural interaction and for an automated detection of the beta-wave. Twenty normal hearing subjects with verified normal directional hearing and speech intelligibility in noise were included in our study. In all of these subjects, the BICs exhibited a characteristic concentration of energy in the time-scale domain which allowed for an automated detection of the beta-wave. Moreover, our study provides an explanation why the beta-wave is hard to detect for larger interaural time delays using time-scale entropy based arguments. It is concluded that time-scale representations of auditory brainstem responses are well suited for the analysis of binaural interaction and allow for an automated detection of the beta-wave.

Interaural time coincidence detectors are present at birth: evidence from binaural interaction

Binaural processing of sounds in mammals is presumably initiated within the auditory nuclei of the caudal pons. The binaural difference waveform (BD) can be derived from the sum of the waveforms evoked by right monaural clicks plus left monaural clicks minus the waveform evoked by binaural clicks. In adults, the BD's first positive peak (beta) is large only for stimuli with interaural time differences (ITDs) that produce a fused acoustic percept. Humans at birth can localize and discriminate sound sources, but their head circumference is about two-thirds of an adult head. In order to test whether beta is related to head circumference, we recorded beta in human neonates as a function of ITD. Binaural clicks with ITDs ranging between 0 and 1000 micros were used to derive BD waveforms in 34 neonates. For ITD=0, beta was detectable in 56% of newborns. The incidence of beta detection then decreased as ITD increased. Only 9% of the babies had detectable beta for all ITDs. No correlation was found between the existence of beta and other properties of the monaural or binaural auditory brainstem response. The finding that for some infants beta was present for all ITDs up to 1.0 ms suggests that there is no recalibration of brainstem delay lines with head growth. Our data suggest that the brainstem auditory pathway for detecting interaural time differences in the adult is probably present at birth. Maturational factors such as increased myelination and greater firing synchrony probably improve the detectability of beta with age. The second peak in the BD waveform (delta) was highly correlated with the existence of wave VI in the binaural and monaural waveforms.

Effects of interaural frequency difference on binaural fusion evidenced by electrophysiological versus psychoacoustical measures

The binaural interaction component (BIC=sum of monaural-true binaural) of the auditory brainstem response appears to reflect central binaural fusion/lateralization processes. Auditory middle-latency responses (AMLRs) are more robust and may reflect more completely such binaural processing. The AMLR also demonstrates such binaural interaction. The fusion of dichotically presented tones with an interaural frequency difference (IFD) offers another test of the extent to which electrophysiological and psychoacoustical measures agree. The effect of IFDs on both the BIC of the AMLR and a psychoacoustical measure of binaural fusion thus were examined. The perception of 20-ms tone bursts at/near 500 Hz with increasing IFDs showed, first, a deviated sound image from the center of the head, followed by clearly separate pitch percepts in each ear. Thresholds of detection of sound deviation and separation (i.e., nonfusion) were found to be 57 and 209 Hz, respectively. However, magnitudes of BICs of the AMLR were found to remain nearly. constant for IFDs up to the 400-Hz (limit of range tested), suggesting that the AMLR-BIC does not provide an objective index of this aspect of binaural processing, at least not under the conditions examined. The nature of lateralization due to IFDs and the concept of critical bands for binaural fusion are also discussed. Further research appears warranted to investigate the significance of the lack of effect of IFDs on the AMLR-BIC. Finally, the IFD paradigm itself would seem useful in that it permits determination of the limit for nonfusion of sounds presented binaurally, a limit not accessible via more conventional paradigms involving interaural time, phase, or intensity differences.

Dipole source analysis of auditory brain stem responses evoked by lateralized clicks

The objective of this paper was to elucidate the relation between psychophysical lateralization and the neural generators of the corresponding auditory evoked potentials. Auditory brain stem responses to binaural click stimuli with different interaural time- and level differences were obtained in 12 subjects by means of multi-channel EEG recording. Data were modeled by equivalent current dipoles representing the generating sources in the brain. A generalized maximum-likelihood method was used to solve the inverse problem, taking into account the noise covariance matrix of the data. The quality of the fit was assessed by computing the goodness-of-fit as the outcome of a chi 2-test. This measure was advantageous compared to the conventionally employed residual variance. At the latency of Jewett wave V, there was a systematic variation of the moment of a rotating dipole with the lateralization of the stimulus. Dipole moment trajectories of stimuli with similar lateralization were similar. A sign reversal of the interaural differences resulted in a mirrored trajectory. Centrally-perceived stimuli corresponded to dipoles with the largest vertical components. With increasing lateralization, the vertical component of the moment decreased, while the horizontal components increased. The similarity of trajectories inducted by the same lateralization show that interaural time- and level differences are not processed independently. The present data support the notion that directional information is already extracted and represented at the level of the brain stem.

Equivalent dipoles of the binaural interaction components and their comparison with binaurally evoked human auditory 40 Hz steady-state evoked potentials

OBJECTIVE

The purpose of this study was to acquire the Binaural Interaction (BI) components of the auditory middle-latency steady-state 40 Hz potentials, compare them with those of the binaurally evoked 40 Hz response and with transient-evoked Auditory Middle Latency Evoked Potentials (AMEP) and suggest possible contributors and generators of the composite 40 Hz BI.

METHODS

Potentials were recorded from 15 normal-hearing adults in response to 40/sec clicks. BI was derived by subtracting the binaurally evoked potentials from the algebraic sum of the evoked potentials to left and to right ear stimulation. Latencies, magnitudes and orientations of the dipole equivalents of 40 Hz components were compared with their BI counterparts, as estimated by three-channel Lissajous' trajectories. Comparison of the transient AMEP to binaural stimulation with the BI of the steady-state 40 Hz response was also conducted to elucidate the contributions of different levels along the auditory pathway to the 40 Hz BI responses.

RESULTS

Each cycle of the BI of the steady-state 40 Hz AMEP included four components that corresponded in latency, amplitude, and dipole orientation to their counterparts in the binaurally evoked waveform. Amplitudes of BI components were 50 to 60% of the respective values in the binaurally evoked potentials. Orientations of BI components matched those of the cortical components in the transient-evoked AMEP.

CONCLUSIONS

The results suggest that the main contribution to the 40 Hz BI is from rate resistant thalamo-cortical neurons. The results also suggest that the binaural cortical neurons contributing to the 40 Hz BI are less affected by increased rate than monaural neurons.

Electrophysiologic correlates of direction and elevation cues for sound localization in the human brainstem

Our objective was to study the effects of sound source direction and elevation on human brainstem electrical activity associated with sound localization. The subjects comprised 15 normal-hearing and symmetrically hearing adults Auditory brainstem evoked potentials (ABEPs) were recorded from three channels, in response to alternating-polarity clicks, presented at a rate of 21.1/s, at nine virtual spatial locations with different direction and elevation attributes Equivalent dipoles of the binaural interaction components (BICs) of ABEPs were derived by subtracting the response to binaural clicks at each spatial location from the algebraic sum of monaural responses to stimulation of each ear in turn. The BICs included two major components corresponding in latency to the vertex-neck-recorded components V and VI of ABEP. A significant decrease of the first BIC's equivalent dipole magnitude was observed for clicks in the horizontal-frontal position (no elevation) in the midsagittal plane, and for clicks in the left-horizontal (no elevation) and right diagonally above the head (medium elevation) positions in the coronal plane, compared to clicks positioned directly above the head. Significant effects on equivalent dipole latencies of this component were found for front-back positions in the midsagittal plane and left-right positions in the coronal plane, compared to clicks positioned directly above the head. The most remarkable finding was a significant change in equivalent dipole orientations across stimulus conditions. We conclude that the changes in BIC equivalent dipole latency, amplitude and orientation across stimulus conditions reflect differences in the distribution of binaural pontine activity evoked by sounds in different spatial locations.

Comparison of binaural auditory brainstem responses and the binaural difference potential evoked by chirps and clicks

Rising chirps that compensate for the dispersion of the travelling wave on the basilar membrane evoke larger monaural brainstem responses than clicks. In order to test if a similar effect applies for the early processing stages of binaural information, monaurally and binaurally evoked auditory brainstem responses were recorded for clicks and chirps for levels from 10 to 60 dB nHL in steps of 10 dB. Ten thousand sweeps were collected for every stimulus condition from 10 normal hearing subjects. Wave V amplitudes are significantly larger for chirps than for clicks for all conditions. The amplitude of the binaural difference potential, DP1-DN1, is significantly larger for chirps at the levels 30 and 40 dB nHL. Both the binaurally evoked potential and the binaural difference potential exhibit steeper growth functions for chirps than for clicks for levels up to 40 dB nHL. For higher stimulation levels the chirp responses saturate approaching the click evoked amplitude. For both stimuli the latency of DP1 is shorter than the latency of the binaural wave V, which in turn is shorter than the latency of DN1. The amplitude ratio of the binaural difference potential to the binaural response is independent of stimulus level for clicks and chirps. A possible interpretation is that with click stimulation predominantly binaural interaction from high frequency regions is seen which is compatible with a processing by contralateral inhibitory and ipsilateral excitatory (IE) cells. Contributions from low frequencies are negligible since the responses from low frequencies are not synchronized for clicks. The improved synchronization at lower frequencies using chirp stimuli yields contributions from both low and high frequency neurons enlarging the amplitudes of the binaural responses as well as the binaural difference potential. Since the constant amplitude ratio of the binaural difference potential to the binaural response makes contralateral and ipsilateral excitatory interaction improbable, binaural interaction at low frequencies is presumably also of the IE type. Another conclusion of this study is that the chirp stimuli employed here are better suited for auditory brainstem responses and binaural difference potentials than click stimuli since they exhibit higher amplitudes and a better signal-to-noise ratio.

Origin of the binaural interaction component in wave P4 of the short-latency auditory evoked potentials in the cat: evaluation of serial depth recordings from the brainstem

There is no general agreement on the origin of the binaural interaction (BI) component in auditory brainstem responses (ABRs). To study this issue the ABRs to monaural and binaural clicks with various interaural time differences (ITDs) were simultaneously recorded from the vertex and from a recording electrode aiming at the superior olive (SO) in cats. Electrode path was along the fibers of the lateral lemniscus (LL). Binaural difference potentials (BDPs), which were computed by subtracting the sum of the two monaural responses from the binaural response, were obtained at systematic depths and across a range of ITD values. It was observed that only a specific BDP deflection recorded at the level at which lemniscal fibers terminate in the nuclei of LL coincided in time with the most prominent BDP in the cat's vertex-recorded ABRs, the BDP in their wave P4. As ITD was increased, the latency shifts and amplitude decrements of the scalp-recorded far-field BDP wave exactly followed those recorded at this lemniscal near-field BDP locus. The data support our hypothesis that the BI component in wave P4 results from a binaural reduction in dischargings of axons ascending in the LL, with this reduction due to contralateral inhibition of the discharge activity of the inhibitory-excitatory units in the lateral nucleus of the SO. Furthermore, at the level of the SO, the BDP in the responses to contra-leading binaural clicks always had larger magnitudes than those evoked by ipsi-leading ones. This bilateral asymmetry is consistent with the view that the BDP in scalp-recorded ABRs is related to the function of sound lateralization.

Auditory brain stem responses evoked by lateralized clicks: is lateralization extracted in the human brain stem?

The dependence of binaurally evoked auditory brain stem responses and the binaural difference potential on simultaneously presented interaural time and level differences is investigated in order to assess the representation of stimulus lateralization in the brain stem. Auditory brain stem responses to binaural click stimuli with all combinations of three interaural time and three interaural level differences were recorded from 12 subjects and 4 channels. The latency of Jewett wave V is shortest for zero interaural time difference and longest for the trading stimuli. The amplitude of wave V is largest for centrally perceived stimuli, i.e., the diotic and trading stimuli, and smallest for the most laterally perceived stimuli. The latency of the most prominent peak of the binaural difference potential DN1 mainly depends on the interaural time difference. The amplitude of the components of the binaural difference potential, DP1-DN1, depends similarly on stimulus conditions as wave V amplitude in the case of the binaural stimuli: smallest amplitudes are found for the most lateral stimuli and largest amplitudes for central stimuli. The results demonstrate that interaural level and time differences are not processed independently. This supports the hypothesis that directional information in humans is already extracted and represented at the level of the brain stem.

Contribution of click frequency bands to the human binaural interaction components

The purpose of this study was to determine the contribution of click frequency bands (broad-band, >2000 Hz, <2000 Hz and <1000 Hz) to binaural interaction components (BICs) of the human auditory brainstem evoked potentials (ABEPs). The human BICs were studied by subtracting the potentials to binaural clicks from the algebraic sum of monaurally evoked potentials to either ear. Effective frequency bands were derived using clicks alone or clicks with ipsilateral or binaural masking noise, high- or low-pass filtered at different cut-off frequencies. Analysis included single-channel vertex-cervical spinous process VII derivation of BIC and ABEP, as well as estimating the single, centrally located dipole equivalent of the surface activity from three orthogonally positioned electrode pairs, using the three-channel Lissajous' trajectory (3-CLT) analysis. All BIC 3-CLTs included three major components (labeled BdII, BeI, and BeII) approximately corresponding in latency to IIIn, V and VI ABEP peaks. All apex latencies of BIC 3-CLT, except BeI, were longer in response to <2000 Hz and <1000 Hz (low-frequency) effective clicks. Apex amplitude of components BeI and BeII of BIC 3-CLT were smaller with low-frequency effective clicks than with broad-band or high-frequency (>2000 Hz) clicks. We suggest that binaural interaction component BeI is mainly tuned to high frequencies, showing no frequency effect on latency, and decreasing in amplitude with decreasing click high frequency content. In contrast, BdII and BeII of the human BICs are evoked more synchronously by high-frequency binaural inputs, but are also sensitive to low frequencies, increasing in latency according to the cochleotopic activation pattern. These differences between BIC components may reflect their roles in sound localization.

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.

Binaural masking level difference in human binaural interaction components

OBJECTIVE

The purpose of this study was to compare the effects of monaural and binaural broadband masking noise on binaural interaction components (BICs) of the human auditory brain stem evoked potentials (ABEPs).

DESIGN

The BICs of the human ABEPs were studied by subtracting the potentials to binaural clicks from the algebraic sum of monaurally evoked potentials to clicks alone or to clicks with ipsilateral monaural or binaural broadband masking noise. Alternating polarity, 11/sec clicks were presented at 65 dB nHL, and noise was presented at 45 dB nHL. Analysis included peak-to-prestimulus baseline amplitudes and latencies of BICs' peaks and troughs from the vertex-mastoid (A) and vertex-neck (Z) channels. In addition, 3-channel Lissajous' trajectory (3-CLT) analysis, estimating the single, centrally located dipole equivalent of surface activity, was performed on data recorded from three orthogonally positioned electrode pairs. 3-CLT measures included apex latency, amplitude, and orientation, as well as planar segment duration, size, shape, and orientation.

RESULTS

All BICs 3-CLTs included five main components (labeled BdI, BdII, BdIII, BeI, and BeII). In general, apex latencies were longer with masking noise. However, BdII and BeI apex latencies were shorter with binaural than with ipsilateral monaural masking noise. Apex amplitude and planar segment size of component BeI, as well as P1 peak amplitude in BICs of the Z-channel records, were larger with binaural than with monaural noise. No significant difference between the monaural and binaural noise conditions was found in durations, shapes, and orientations of planar segments of BICs 3-CLT, nor in peak latency of BICs in the A- and Z-channel records.

CONCLUSIONS

We suggest that these effects on the latency and amplitude of BICs reflect binaural processing in the human brain stem. In particular, the larger amplitudes and shorter latencies of P1 and BeI with binaural than with ipsilateral monaural masking may be associated with the psychophysical effect of binaural masking level difference.

The effect of binaural masking noise disparity on human auditory brainstem binaural interaction components

The binaural interaction components (BIC) of the human auditory brainstem responses have been associated with sound lateralization which involves analyzing correlated inputs from the two ears. To test the hypothesis that BIC generators are specifically sensitive to binaural, correlated sounds, the effects of monaural and binaural correlated and uncorrelated masking on BIC to clicks were compared. Analysis included peak-to-prestimulus baseline amplitudes and latencies of BIC peaks from the vertex-mastoid ('A') and vertex-neck ('Z') channels, as well as the three-channel Lissajous trajectory (3-CLT) measures. Trajectory amplitudes of BIC BdIII, BeI and BeII were significantly suppressed by correlated (but not by uncorrelated) binaural noise, when compared with the unmasked condition. Moreover, component BdIII was more affected by masking with correlated than with uncorrelated binaural noise. Overall, binaural noise was more effective in suppressing BIC then monaural noise, and interaurally correlated binaural noise was more effective than uncorrelated binaural noise. These results are compatible with BIC generation by a binaurally activated subset of central auditory neurones which is sensitive to interaurally correlated sounds. Such a subset has been associated with the superior olivary complex and is assumed to be involved in sound lateralization.

Interaural delay-dependent changes in the binaural difference potential in cat auditory brainstem response: implications about the origin of the binaural interaction component

Auditory brainstem responses (ABRs) evoked by dichotic clicks with 12 different interaural delays (ITDs) between 0 and 1500 microsecond(s) were recorded from the vertices of 10 cats under ketamine anesthesia. The so-called binaural difference potential (BDP), considered to be an indicator of binaural interaction (BI), was computed by subtracting the sum of the two monaural responses from the binaural one. The earliest and most prominent component of BDP was a negative deflection (DN1) at a latency between 4 and 4.8 ms. Like all the other components of BDP, DNI was also due to binaural reduction rather than enhancement of the corresponding ABR wave, P4 in this case. Furthermore, the way its latency increased as a function of ITD was also not compatible with what would be predicted by the delay-line coincidence detector models based on the excitatory-excitatory units in the medial superior olive (MSO). We therefore proposed an alternative hypothesis for the origin of this BI component based on the inhibitory-excitatory (IE) units in the lateral superior olive (LSO). The computational model designed closely simulated the ITD-dependent attenuation and latency shifts observed in DN1. It was therefore concluded that the origin of this BI component in the cat's vertex-ABR could be the lateral lemniscal output of the LSO, although the delay lines which have been shown to exist also in the mammalian brain may play an important role in encoding ITDs.

Binaural interaction and the effects of stimulus intensity and repetition rate in human auditory brain-stem

Binaural interaction (BI) components in brain-stem auditory evoked potential (BAEP) and their changes with stimulus intensity and repetition rate were examined in human adult. Seven BI components were identified, which occurred between the latency range of 5 and 11 ms and coincided consistently with the latency range of BAEP waves IV-VII. Waves DV and DVII, occurring at the downslopes of BAEP waves V and VII, respectively, were the two most prominent and reproducible BI components. Wave DVII existed consistently at high, moderate and, in most cases, low stimulus intensities, suggesting that this component is neurogenic although acoustic cross-talk may account for a part of its waveform at high stimulus intensities. The latencies of all BI components increased as a function of decreasing stimulus intensity, while the interpeak intervals, especially DV-DVII, were essentially constant at different intensity levels. The amplitudes of BI components decreased slightly with decreasing intensity. As click repetition rate increased, BI wave latencies and interpeak intervals increased slightly and amplitudes decreased slightly. When repetition rate increased to above 20/s, BI components became poorly differentiated. Lower repetition rates, e.g. 10/s, are therefore preferred for routine derivation of the BI. The changes in the latency and amplitude of BI components with stimulus intensity and repetition rate were associated or concomitant with those of the corresponding BAEP components in monaural and binaural potentials. In view of the concomitant relationship between BI and BAEP latency, we designate BI components in association with the corresponding BAEP components.

Binaural interaction in human neonatal auditory brainstem

Binaural interaction (BI) in brainstem auditory evoked response (BAER) were examined in normal term neonates. The BI components coincided consistently with the latency range of BAER wave IV through wave VII. Most BI components seen in the adults could be identified in the neonates, but the later components, i.e. those with longer latency, were underdeveloped in wave form. Wave DV was the most consistent and reproducible BI component. A marked difference between the neonatal and adult BI wave forms was that wave DVII was particularly small in the neonates. It appears that neuronal responses contributing to later BI components such as wave DVII are particularly immature at birth. Wave latencies and interpeak intervals were longer and amplitudes were smaller in the neonates than in the adults, which was associated with the differences between the neonates and adults in the BAER components. Changes in the BI components with stimulus intensity and rate in the neonates were fundamentally similar to but more significant compared with those in the adults. These findings suggest that neural connections in human auditory brainstem subserving the BI are established at birth but, particularly at higher levels of the brainstem, are immature.

Three-channel Lissajous' trajectory of the binaural interaction components of human auditory middle-latency evoked potentials

Three-channel Lissajous' trajectories (3-CLTs) of the binaural interaction component (BI) of auditory middle latency evoked potentials (AMLEPs) were derived from 14 normally hearing adults by subtracting the response to binaural clicks from the algebraic sum of monaural responses. AMLEPs were recorded in response to 65 dB nHL, rarefaction clicks, presented at a rate of 3.3/s. A normative set of BI 3-CLT measures was calculated and compared with the corresponding measures of simultaneously recorded, single-channel vertex-left mastoid and vertex-neck derivations of BI and of AMLEP to binaural stimulation (B). 3-CLT measures included: apex latency, amplitude and orientation, as well as planar segment duration, orientation, size and shape. The results showed seven main apices and associated planar segments ('Be', 'Bf', 'Bg', 'Bh', 'Bi1', 'Bi2' and 'Bj') in the 3-CLT of BI. Apex latencies of the BI 3-CLT were comparable to peak latencies of the vertex-left mastoid and vertex-neck AMLEP and BI records, both in their absolute values and in intersubject variability. Durations of BI planar segments were approximately 5.0 ms. Apex amplitudes of BI 3-CLT were larger than the respective peak amplitudes of the vertex-mastoid and vertex-neck BI records, while their intersubject variabilities were comparable. The lateralization of BI components may indicate asymmetric processing of binaural auditory input, or may be connected with anatomical asymmetry such as skull thickness. Preliminary analyses did not reveal a clear correlation between the lateralization of the BI component 'Bi2' and the handedness of the subject. We suggest that BI components of AMLEP may be associated with the primary auditory cortex and subcortical ascending structures.

The effect of broad-band noise on the binaural interaction components of human auditory brainstem-evoked potentials

Three-channel Lissajous trajectories (3-CLTs) of binaural interaction components (BI) of auditory brainstem potentials (ABEPs) were derived from 13 normally hearing adults by subtracting the response to binaural clicks from the algebraic sum of monaurally evoked responses to clicks. ABEPs were recorded in response to 65 dB nHL, alternating-polarity clicks, presented at a rate of 11/s. The procedure was repeated with clicks alone as well as with clicks with broad-band masking noise. Noise was presented at 25 and 45 dB nHL, producing a signal-to-noise ratio of +40 and +20 dB, respectively. All BI 3-CLTs included 6 planar segments (labeled BdI, BdII, BdIII, BeI, BeII and Bf) whose apex latencies, except Bf, increased with increasing noise level above 25 dB nHL, and whose durations, sizes, shapes and orientations did not change across noise levels. There were also significant increases in peak latencies of the BI from single channels vertex-mastoid and vertex-neck with increasing noise level. No significant change was found in the trajectory amplitude of apices, with the exception of apices BdIII and Bf whose amplitudes increased with increasing noise level. We suggest that the paradoxical increase in BI amplitude with masking noise may reflect a binaural enhancement of the effect of noise. The effects observed indicate that, whereas the response to clicks displays occlusion, the response to noise displays spatial facilitation at the brainstem level.

Effects of click polarity on the binaural interaction components of human auditory brainstem-evoked potentials: a three-channel Lissajous trajectory study

Three-channel Lissajous trajectories (3-CLTs) of the binaural interaction components of the auditory brainstem-evoked potentials were recorded from 17 adult subjects in response to rarefaction, condensation and alternating polarity clicks. All 3-CLTs included 3 planar segments (named Bd, Be and Bf) whose latencies, amplitudes, orientations, sizes and shapes were not affected by click polarity. A significant increase was found in the duration of planar segment Be to alternating polarity clicks. This effect may be explained by limitations of spatiotemporal resolution of the method, which did not allow distinction of contributions from temporally overlapping generators participating in binaural processing.

Three-channel Lissajous' trajectory of the binaural interaction components in human auditory brain-stem evoked potentials

The 3-channel Lissajous' trajectory (3-CLT) of the binaural interaction components (BI) in auditory brain-stem evoked potentials (ABEPs) was derived from 17 normally hearing adults by subtracting the response to binaural clicks (B) from the algebraic sum of monaural responses (L + R). ABEPs were recorded in response to 65 dB nHL, alternating polarity clicks, presented at a rate of 11/sec. A normative set of BI 3-CLT measures was calculated and compared with the corresponding measures of simultaneously recorded, single-channel vertex-left mastoid and vertex-neck derivations of BI and of ABEP L + R and B. 3-CLT measures included: apex latency, amplitude and orientation, as well as planar segment duration and orientation. The results showed 3 apices and associated planar segments ("BdII," "Be" and "Bf") in the 3-CLT of BI which corresponded in latency to the vertex-mastoid and vertex-neck peaks IIIn, V and VI of ABEP L + R and B. These apices corresponded in latency and orientation to apices of the 3-CLT of ABEP L + R and ABEP B. This correspondence suggests generators of the BI components between the trapezoid body and the inferior colliculus output. Durations of BI planar segments were approximately 1.0 msec. Apex amplitudes of BI 3-CLT were larger than the respective peak amplitudes of the vertex-mastoid and vertex-neck recorded BI, while their intersubject variabilities were comparable.

Origin of the click-evoked binaural interaction potential, beta, of humans

The human click-evoked binaural difference waveform has as its most prominent feature the peak, beta, which has been shown to be related to binaural perception. In normal human subjects, we investigated the effect upon beta of (1) delivering the clicks in the presence of high passed masking noise (4000 Hz cut-off) and (2) reversing click polarity. In the presence of the masker, little activity occurs at the time the click-evoked beta would be expected. No significant change in beta latency occurs when the click polarity is inverted. We conclude that beta is principally due to the high-frequency components of the broad band click, so that it is through the activity in high characteristic frequency auditory nerve fibers that click-evoked beta is generated. Because the medial superior olive is the major nucleus of the human superior olivary complex, our results suggest that beta is possibly generated by the high-frequency cells of the medial superior olive.

Binaural interaction in the brain-stem auditory evoked potential: evidence for a delay line coincidence detection mechanism

The binaural interaction component (BIC) of the brain-stem auditory evoked potential (BAEP) was studied in 13 normally hearing adults by subtracting the response to binaural clicks from the algebraic sum of monaural responses. Eight or 16 electrodes on the head and neck were referred to a non-cephalic site, the binaural stimuli were delivered either simultaneously or with an inter-aural time difference (delta t) of 0.2-1.6 msec, and masking noise was presented to the non-stimulated ear. With simultaneous binaural clicks a BIC was identifiable in every subject, the most consistent peaks being a scalp-positive potential (P1) peaking approximately 0.2 msec after wave V and a scalp negativity (N1) 0.7 msec later. Similar potentials were identifiable in 6/7 subjects with delta t of 0.4 msec, 5/7 at 0.8 msec but only 1/7 at 1.2 msec. This suggests that the BIC may be associated with sound localization mechanisms which are sensitive to a similar range of delta t. On increasing delta t from 0.0 to 0.8 msec, the BIC was progressively delayed by approximately half the inter-aural time difference, with no suggestion of increasing temporal dispersion. This supports the notion of a 'delay line coincidence detection' mechanism in which the BIC represents the output of binaurally responsive neurones, probably in the superior olivary complex, which are 'tuned' to a particular delta t by the relative lengths of presynaptic axons relaying input from either ear. The distribution of the BIC in sagittal and coronal electrode chains was compared with that of binaural BAEP components I-VI and found to bear the closest resemblance to wave IV. It is suggested that both components may originate largely in the lateral lemnisci.

Intra-ponto-mesencephalic recording of binaural interaction in human brain-stem auditory evoked potentials

Brain-stem auditory evoked potentials (BAEPs) were recorded at intraparenchymatous sites along a ponto-mesencephalic stereotactic penetration path in a patient with the rare condition of a ponto-medullary lesion which required biopsy but did not grossly alter scalp BAEPs. Click stimuli were applied either monaurally (with contralateral masking noise against acoustic cross-talk; conditions 'R,' 'L') or binaurally (condition 'RL'). A binaural interaction trace ('BI') was derived by subtracting the sum of the monaural from the binaural responses: BI = (RL)-(R + L). Despite failure to obtain significant BI components above noise level for scalp BAEPs, at the lower pons clearly discernible, multiphasic BI activity could be recorded beginning at the peak latency of scalp wave III and extending over approximately the next 4 msec. Its amplitude rapidly fell off with distance toward more rostral, mesencephalic recording sites. In relation to this positive finding, the equivocality among some of the previous studies on the detection of BI components in human scalp BAEPs is tentatively rephrased in terms mainly of a low signal-to-noise ratio and of functional peculiarities introduced by the respective stimulation protocols.

Auditory brainstem responses to tonal stimuli in young and aging rats

The auditory brain stem response (ABR) was studied in young adult and aged rats using 3,8 and 40 kHz tone pips. The expected inverse relationship between frequency and latency was observed in the younger group for waves I, II and III, while the response to the highest frequency stimulus had the longest latency at wave V. Absolute latencies for waves I through V each showed age-related increments with more pronounced changes occurring to 3 and 40 kHz stimuli than to the frequency of maximum sensitivity (8 kHz). Threshold increases with age for the highest frequency approximately doubled those for the lower frequencies. Examination of interpeak intervals (IPI) I-III, III-V and I-V revealed aging effects. The largest IPI I-V increment occurred to 3 kHz stimulation which reflects changes at both I-III and III-V sub-intervals. These results demonstrate electrophysiological correlates of aging due to transformations in the peripheral auditory system coupled with alterations in brainstem auditory pathways.