Auditory evoked magnetic fields in patients with absent brainstem responses due to auditory neuropathy with optic atrophy

Pathophysiology of Postoperative Hearing Disorders after Vestibular Schwannoma Resection: Insights from Auditory Brainstem Response and Otoacoustic Emissions

Background: In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods: Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists-MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results: In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion: a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery.

Limiting parameter range for cortical-spherical mapping improves activated domain estimation for attention modulated auditory response

BACKGROUND

Attention is one of the factors involved in selecting input information for the brain. We applied a method for estimating domains with clear boundaries using magnetoencephalography (the domain estimation method) for auditory-evoked responses (N100m) to evaluate the effects of attention in milliseconds. However, because the surface around the auditory cortex is folded in a complicated manner, it is unknown whether the activity in the auditory cortex can be estimated.

NEW METHOD

The parameter range to express current sources was set to include the auditory cortex. Their search region was expressed as a direct product of the parameter ranges used in the adaptive diagonal curves.

RESULTS

Without a limitation of the range, activity was estimated in regions other than the auditory cortex in all cases. However, with the limitation of the range, the activity was estimated in the primary or higher auditory cortex. Further analysis of the limitation of the range showed that the domains activated during attention included the regions activated during no attention for the participants whose amplitudes of N100m were higher during attention.

COMPARISON WITH EXISTING METHOD

We proposed a method for effectively limiting the search region to evaluate the extent of the activated domain in regions with complex folded structures.

CONCLUSION

To evaluate the extent of activated domains in regions with complex folded structures, it is necessary to limit the parameter search range. The area of the activated domains in the auditory cortex may increase by attention on the millisecond timescale.

Factors Affecting the Variation of Maximum Speech Intelligibility in Patients With Sensorineural Hearing Loss Other Than Apparent Retrocochlear Lesions

OBJECTIVES

To examine the relationship between speech intelligibilities among the similar level of hearing loss and threshold elevation of the auditory brainstem response (ABR).

METHODS

The relationship between maximum speech intelligibilities among similar levels of hearing loss and relative threshold elevation of the click-evoked ABR (ABR threshold - pure tone average at 2,000 and 4,000 Hz) was retrospectively reviewed in patients with sensorineural hearing loss (SNHL) other than apparent retrocochlear lesions as auditory neuropathy, vestibular schwannoma and the other brain lesions.

RESULTS

Comparison of the speech intelligibilities in subjects with similar levels of hearing loss found that the variation in maximum speech intelligibility was significantly correlated with the threshold elevation of the ABR.

CONCLUSION

The present results appear to support the idea that variation in maximum speech intelligibility in patients with similar levels of SNHL may be related to the different degree of dysfunctions of the inner hair cells and/or cochlear nerves in addition to those of outer hair cells.

Positive auditory cortical responses in patients with absent brainstem response

OBJECTIVE

To compare the detectability of the different auditory evoked responses in patients with retrocochlear lesion.

METHODS

The 40-Hz auditory steady state response (ASSR) and the N1m auditory cortical response were examined by magnetoencephalography in 4 patients with vestibular schwannoma, in whom the auditory brainstem response (ABR) was absent.

RESULTS

Apparent N1m responses were observed despite total absence of the ABR or absence except for small wave I in all patients, although the latency of N1m was delayed in most patients. On the other hand, clear ASSFs could be observed only in one patient. Very small 40-Hz ASSFs could be detected in 2 patients (amplitude less than 1fT), but no apparent ASSFs were observed in one patient, in whom maximum speech intelligibility was extremely low and the latency of N1m was most prolonged.

CONCLUSION

The N1m response and 40-Hz ASSR could be detected in patients with absent ABR, but the N1m response appeared to be more detectable than the 40-Hz ASSR.

SIGNIFICANCE

Combined assessment with several different evoked responses may be useful to evaluate the disease conditions of patients with retrocochlear lesions.