The Practice of Evoked Potential Audiometry

Auditory brainstem functioning in individuals with misophonia

Purpose

Misophonia is not investigated much from an audiological perspective. Our study aims to examine the processing of the auditory retro-cochlear pathways in individuals with misophonia.

Methods

A cross-sectional study was conducted among university students who had misophonia. The revised Amsterdam Misophonia Scale was used to determine the severity of misophonia. Participants were divided into mild and moderate-severe misophonia and compared with the healthy control group. Auditory Brainstem Response testing was recorded from all the individuals with misophonia. The absolute latency, amplitude, inter-peak latency difference, and inter-rate latency difference were compared between the groups.

Results

One-way ANOVA result showed no significant difference in all the parameters of auditory brainstem response between the groups. These results are suggestive of normal brainstem processing in individuals with misophonia.

Conclusions

The study concludes that the auditory pathway up to brainstem areas is intact in individuals with misophonia. Further studies are essential on a larger population for generalizing the results.

Cortical Neurophysiologic Correlates of Auditory Threshold in Adults and Children With Normal Hearing and Auditory Neuropathy Spectrum Disorder

Purpose Auditory threshold estimation using the auditory brainstem response or auditory steady state response is limited in some populations (e.g., individuals with auditory neuropathy spectrum disorder [ANSD] or those who have difficulty remaining still during testing and cannot tolerate general anesthetic). However, cortical auditory evoked potentials (CAEPs) can be recorded in many such patients and have been employed in threshold approximation. Thus, we studied CAEP estimates of auditory thresholds in participants with normal hearing, sensorineural hearing loss, and ANSD. Method We recorded CAEPs at varying intensity levels to speech (i.e., /ba/) and tones (i.e., 1 kHz) to estimate auditory thresholds in normal-hearing adults (n = 10) and children (n = 10) and case studies of children with sensorineural hearing loss and ANSD. Results Results showed a pattern of CAEP amplitude decrease and latency increase as stimulus intensities declined until waveform components disappeared near auditory threshold levels. Overall, CAEP thresholds were within 10 dB HL of behavioral thresholds for both stimuli. Conclusions The above findings suggest that CAEPs may be clinically useful in estimating auditory threshold in populations for whom such a method does not currently exist. Physiologic threshold estimation in difficult-to-test clinical populations could lead to earlier intervention and improved outcomes.

Auditory cortical activity to different voice onset times in cochlear implant users

OBJECTIVE

Voice onset time (VOT) is a critical temporal cue for perception of speech in cochlear implant (CI) users. We assessed the cortical auditory evoked potentials (CAEPs) to consonant vowels (CVs) with varying VOTs and related these potentials to various speech perception measures.

METHODS

CAEPs were recorded from 64 scalp electrodes during passive listening in CI and normal-hearing (NH) groups. Speech stimuli were synthesized CVs from a 6-step VOT /ba/-/pa/ continuum ranging from 0 to 50 ms VOT in 10-ms steps. Behavioral measures included the 50% boundary point for categorical perception ("ba" to "pa") from an active condition task.

RESULTS

Behavioral measures: CI users with poor speech perception performance had prolonged 50% VOT boundary points compared to NH subjects. The 50% boundary point was also significantly correlated to the ability to discriminate consonants in quiet and noise masking. Electrophysiology: The most striking difference between the NH and CI subjects was that the P2 response was significantly reduced in amplitude in the CI group compared to NH. N1 amplitude did not differ between NH and CI groups. P2 latency increased with increases in VOT for both NH and CI groups. P2 was delayed more in CI users with poor speech perception compared to NH subjects. N1 amplitude was significantly related to consonant perception in noise while P2 latency was significantly related to vowel perception in noise. When dipole source modelling in auditory cortex was used to characterize N1/P2, more significant relationships were observed with speech perception measures compared to the same N1/P2 activity when measured at the scalp. N1 dipole amplitude measures were significantly correlated with consonants in noise discrimination. Like N1, the P2 dipole amplitude was correlated with consonant discrimination, but additional significant relationships were observed such as sentence and word identification.

CONCLUSIONS

P2 responses to a VOT continuum stimulus were different between NH subjects and CI users. P2 responses show more significant relationships with speech perception than N1 responses.

SIGNIFICANCE

The current findings indicate that N1/P2 measures during a passive listening task relate to speech perception outcomes after cochlear implantation.

P300 in individuals with sensorineural hearing loss

Introduction

Behavioral and electrophysiological auditory evaluations contribute to the understanding of the auditory system and of the process of intervention.

Objective

To study P300 in subjects with severe or profound sensorineural hearing loss.

Methods

This was a descriptive cross-sectional prospective study. It included 29 individuals of both genders with severe or profound sensorineural hearing loss without other type of disorders, aged 11 to 42 years; all were assessed by behavioral audiological evaluation and auditory evoked potentials.

Results

A recording of the P3 wave was obtained in 17 individuals, with a mean latency of 326.97 ms and mean amplitude of 3.76 V. There were significant differences in latency in relation to age and in amplitude according to degree of hearing loss. There was a statistically significant association of the P300 results with the degrees of hearing loss (p = 0.04), with the predominant auditory communication channels (p < 0.0001), and with time of hearing loss.

Conclusions

P300 can be recorded in individuals with severe and profound congenital sensorineural hearing loss; it may contribute to the understanding of cortical development and is a good predictor of the early intervention outcome.

Modulation of auditory evoked responses to spectral and temporal changes by behavioral discrimination training

Background

Due to auditory experience, musicians have better auditory expertise than non-musicians. An increased neocortical activity during auditory oddball stimulation was observed in different studies for musicians and for non-musicians after discrimination training. This suggests a modification of synaptic strength among simultaneously active neurons due to the training. We used amplitude-modulated tones (AM) presented in an oddball sequence and manipulated their carrier or modulation frequencies. We investigated non-musicians in order to see if behavioral discrimination training could modify the neocortical activity generated by change detection of AM tone attributes (carrier or modulation frequency). Cortical evoked responses like N1 and mismatch negativity (MMN) triggered by sound changes were recorded by a whole head magnetoencephalographic system (MEG). We investigated (i) how the auditory cortex reacts to pitch difference (in carrier frequency) and changes in temporal features (modulation frequency) of AM tones and (ii) how discrimination training modulates the neuronal activity reflecting the transient auditory responses generated in the auditory cortex.

Results

The results showed that, additionally to an improvement of the behavioral discrimination performance, discrimination training of carrier frequency changes significantly modulates the MMN and N1 response amplitudes after the training. This process was accompanied by an attention switch to the deviant stimulus after the training procedure identified by the occurrence of a P3a component. In contrast, the training in discrimination of modulation frequency was not sufficient to improve the behavioral discrimination performance and to alternate the cortical response (MMN) to the modulation frequency change. The N1 amplitude, however, showed significant increase after and one week after the training. Similar to the training in carrier frequency discrimination, a long lasting involuntary attention to the deviant stimulus was observed.

Conclusion

We found that discrimination training differentially modulates the cortical responses to pitch changes and to envelope fluctuation changes of AM tones. This suggests that discrimination between AM tones requires additional neuronal mechanisms compared to discrimination process between pure tones. After the training, the subjects demonstrated an involuntary attention switch to the deviant stimulus (represented by the P3a-component in the MEG) even though attention was not prerequisite.

Effects of sample size on the noise floor and distortion product otoacoustic emissions

This study investigated the effects of sample size on the noise floor and distortion product otoacoustic emissions (DPOAEs) in 55 normal-hearing subjects as a function of intensity. More specifically, we investigated the effects of sample size (12-400 sweeps) as a function of intensity (L1 = L2 = 35, 45 and 55 dB SPL), firstly, on the identifiability of DPOAEs (2F1-F2), secondly, on the noise floor adjacent to DPOAEs, and thirdly, on the magnitude of DPOAEs centred around geometric means of 531 Hz, 1,000 Hz, 2,000 Hz and 4,000 Hz. Testing was conducted with a commercially available system for measuring DPOAEs (Grason-Stadler, GSI-60). A constant F2:F1 ratio of 1.21 was used. As sample size increased from 12 to 400 sweeps, the noise floors decreased by about 13 dB; this closely corresponds to the expected 15 dB reduction based on the square root rule of noise reduction. The highest noise floors were measured at 531 Hz and the lowest noise floors at 2,000 Hz and 4,000 Hz. Identifiability increased as intensity increased from 35 to 55 dB SPL and as sample size increased from 12 to 400 sweeps for all stimulus conditions. Mean DPOAEs for all frequencies (531-4,000 Hz) appeared to decrease as sample size increased, particularly at stimulus levels of 35 dB and 45 dB SPL. These results may be explained by a reduction in the noise levels within the bandwidth of the DPOAE bin. That is, the DPOAE bin is comprised of the DPOAE plus background noise and these two quantities are not separated within the measured bin. Because the magnitude of bin containing DPOAEs is critically dependent on sample size, clinicians should carefully document this variable when collecting normative data. Similarly, clinicians who compare the magnitude of their DPOAEs to published data should note the sample size employed.

Brainstem auditory evoked responses elicited by tone-burst stimuli in clinically normal dogs

Brainstem auditory evoked responses (BAERs) to click and tone-burst stimuli (0.5, 1, 2, 4, and 8 kHz) were recorded from 32 ears in 16 adult Beagles. BAERs were used to establish a normative database and describe response thresholds and latencies (wave I-IV) for the different stimuli. The frequencies of sound used were 8, 4, 2, 1, and 0.5 kHz. Sound stimuli were delivered by a closed headphone and masking stimuli were not applied. The BAER waveforms obtained were similar to those reported previously, except for a frequency-following response evoked by 1-kHz tone-bursts. The threshold was lowest when clicks and 4-kHz tone-bursts were used. Significant differences were observed between the mean values of the peak latencies for clicks and 4- and 8-kHz tone-bursts. The tone-burst stimulation used in our experiment was shown to be an appropriate method for detecting the BAERs. Thus, for investigating the frequency-specificity of the auditory sense, BAER data obtained using tone-burst sound in dogs may be meaningful.

Bera in high risk children a 5 year hearing evaluation

Very few studies have been done all over the world to find out incidence of hearing loss associated with different risk factors. The objective of this study was to find out incidence of hearing loss in children from High Risk category especially in reference to individual risk factor. Out of 593 children (0-5 year) from High Risk category subjected to B.E.R.A. over last 5 years, 126 (21.4%) showed hearing loss. 202 children (34.06%) from Birth Asphyxia category formed the largest group. Patients with Head and Neck anomaly showed maximum hearing loss (91.66%). 101 (80.15 %) children showed bilateral hearing loss. 57 Ears (4.80%), 67 Ears (5.64%), 99 Ears (8.34%) showed Mild, Moderate and Severe hearing loss respectively. 152 ears (71.31%), 67 ears (29.90%), 4 ears (1.79%) showed Cochlear, Retrocochlear and conductive hearing loss.

Generation of human auditory steady-state responses (SSRs). II: Addition of responses to individual stimuli

In order to investigate the generation of the 40 Hz steady-state response (SSR), auditory potentials evoked by clicks were recorded in 16 healthy subjects in two stimulating conditions. Firstly, repetition rates of 7.9 and 40 Hz were used to obtain individual middle latency responses (MLRs) and 40 Hz-SSRs, respectively. In the second condition, eight click trains were presented at a 40 Hz repetition rate and an inter-train interval of 126 ms. We extracted from the whole train response: (1) the response-segment taking place after the last click of the train (last click response, LCR), (2) a modified LCR (mLCR) obtained by clearing the LCR from the amplitude enhancement due to the overlapping of the responses to the clicks preceding the last within the stimulus train. In comparison to MLRs, the most relevant feature of the evoked activity following the last click of the train (LCRs, mLCRs) was the appearance in the 50-110 ms latency range of one (in 11 subjects) or two (in 2 subjects) additional positive-negative deflections having the same periodicity as that of MLR waves. The grand average (GA) of the 40 Hz-SSRs was compared with three predictions synthesized by superimposing: (1) the GA of MLRs, (2) the GA of LCRs, (3) the GA of mLCRs. Both the MLR and mLCR predictions reproduced the recorded signal in amplitude while the LCR prediction amplitude resulted almost twice that of the 40 Hz-SSR. With regard to the phase, the MLR, LCR and mLCR closely predicted the recorded signal. Our findings confirm the effectiveness of the linear addition mechanism in the generation of the 40 Hz-SSR. However the responses to individual stimuli within the 40 Hz-SSR differ from MLRs because of additional periodic activity. These results suggest that phenomena related to the resonant frequency of the activated system may play a role in the mechanisms which interact to generate the 40 Hz-SSR.

Brainstem auditory evoked responses from birth to adulthood: normative data of latency and interval

Development of wave latency and interpeak interval (IPI) in brainstem auditory evoked responses (BAER) from birth to adulthood was examined. Adult equivalence was reached for most wave latencies and IPIs between the ages of 9 months and 3 years. The observation of the III-V/I-III interval ratio suggests that after term data the I-III IPI decreases more than the III-V IPI. I-III, III-V and I-V IPIs shortened from the l-month old group to the 4-6 year old group by 22%, 15% and 19% respectively. The III-V/I-III interval ration may be a useful BAER measure. Normative data of various BAER measures at different ages are presented. The slope of the L-I function for wave V was slightly steeper in younger groups than in older groups (40 microseconds/dB in the 1-month old group 32 microseconds/dB in the adult group). This change which was accompanied by an age-related difference in the absolute wave latency. It is suggested that age-dependent norms should be used in evaluation of the L-I function.

Auditory function in Duane's retraction syndrome

We obtained audiograms and auditory brainstem responses from 44 patients with Duane's retraction syndrome to assess the incidence and nature of hearing deficit. Of 44 patients, seven (15.9%) had evidence of hearing impairment. Three (6.8%) subjects had a temporary conductive hearing loss because of middle ear fluid, and another patient had hearing loss from Crouzon's disease. The remaining three (6.8%) patients demonstrated sensorineural hearing deficit. This hearing impairment was attributed to a cochlear lesion and not to a pontine lesion. We believe that the frequency of sensorineural hearing loss in these patients warrants hearing screening programs similar to those used for infants in neonatal intensive care units.

Thresholds for short-latency auditory-evoked potentials to tones in notched noise in normal-hearing and hearing-impaired subjects

The thresholds for the short-latency auditory evoked potentials (SLAEPs) to short-duration tones presented in notched-noise masking were evaluated in 20 normal-hearing and 20 hearing-impaired subjects. The differences (dB) between these thresholds (dB nHL) and the pure-tone behavioral thresholds (dB HL) across all 40 subjects were 11.6, 6.1, 6.3 and 0.8 dB for 500, 1,000, 2,000 and 4,000 Hz, respectively. These differences were significantly smaller for the hearing-impaired subjects than for the normal-hearing subjects. Ninety-eight percent of the SLAEP threshold estimations were within 30 dB of the subjects' pure-tone behavioral thresholds and 91% were within 20 dB.

Auditory brain stem responses to bone-conducted tones in infants

The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were recorded from 48 infants with ears exhibiting various external and middle ear states (normal, otitis media, auditory meatal atresia). Amplitudes were greater, wave V latencies longer, and detectability better for responses to 500-Hz BC tones compared to 2,000-Hz BC tones. Overall, most (94% to 100%) infants with normal cochlear sensitivity demonstrate ABRs to 20-dB normal hearing level (nHL) 500-Hz BC tones and 30-dB nHL 2,000-Hz BC tones. In cases in which masking is difficult (eg, bilateral atresia), infant ipsilateral/contralateral ABR asymmetries may help determine from which cochlea a response to the BC tones originates. In conclusion, two-channel ABR recordings to BC tones appear to be feasible for demonstrating normal cochlear sensitivity in infants.

Electrode placement and mode of recording (differential vs. single-ended) effects on the early auditory-evoked response

The effects of electrode placement and mode of recording (single-ended vs. differential) on latencies and amplitudes of the early auditory-evoked response were studied. The following electrode arrays were evaluated (1) vertex-neck, (2) forehead-ear canal (Enhancer I), and (3) vertex-nape. Responses were obtained on 10 normally hearing subjects at sensation levels (SLs) ranging from 15 to 75 dB. Test-retest reliability was excellent for absolute and interwave latencies for all conditions. The reliability of absolute amplitude was poor, and the stability of the amplitude ratios between waves I and V was even worse. No consistent absolute or interwave latency differences were found among electrode montages. The amplitude data suggest that the forehead-ear canal montage is preferred for differential diagnosis because it enhances the probability of detecting wave I. The electrophysiologic threshold for wave I was 5-10 dB lower with the Enhancer I. However, the vertex-neck and vertex-nape combinations are best for estimating auditory sensitivity because they gave the largest wave V amplitudes and 10-dB lower electrophysiologic thresholds. Although the differential vertex-neck and single-ended vertex-nape recordings yielded comparable results, the single-ended montage employs only two electrodes and the test leads do not require rearrangement when the test ear changes.

Bone conduction masking for brainstem auditory-evoked potentials (BAEP) in pediatric audiological evaluations. Validation of the test

A brainstem auditory-evoked potential (BAEP) protocol for testing pediatric patients at risk for conductive hearing impairment was evaluated. The protocol used was: air-conducted click stimuli masked by bone-conducted wide-band noise. The specificity and sensitivity values for the test were determined by means of a blind cross-sectional trial including an active group of patients with an aural malformation and an age-matched control group with a sensorineural impairment. The bone-conducted masking of air-conducted BAEP showed high specificity and sensitivity and was easily administered despite pediatric difficulty. It was useful in differentiating sensorineural from conductive impairment and provided a rough estimate of the cochlear reserve in presumptive conductive hearing loss as great as 60 dB hearing loss. It is concluded that the bone-conducted masking procedure appears to be a great help in the binary decision whether middle ear surgery should be performed in patients at risk for conductive hearing loss, specially children with aural malformations.

Scalp potentials of normal and hearing-impaired subjects in response to sinusoidally amplitude-modulated tones

None of the current electrical audiometric procedures, alone or in combination, has yet achieved the precision of conventional audiometric testing that is used to assess hearing in verbally capable children and adults. The reason for this, in part, lies in the use of stimuli which have a wide frequency content. We have measured scalp potentials which follow the envelopes of sinusoidally amplitude-modulated tones: a frequency-specific stimulus. In normal subjects such amplitude-modulation following responses (AMFRs) appear to be generated by two sources. One source has a latency of about 30 ms, generates large responses and is only observed at modulations below 55 Hz, while the other source has a latency of 7-9 ms, generates smaller responses, and is only observed at modulations from 100-350 Hz. The latencies of these two sources are consistent with origins in the cortex and midbrain, respectively. We examined AMFRs to low frequency (50 Hz) modulations as a possible audiometric tool. In normal subjects, the amplitude of the AMFR increased as a function of intensity, decreased as a function of carrier frequency, and could be evoked across the whole audiometric range (250-8000 Hz). In hearing-impaired subjects, the AMFR amplitudes as a function of carrier frequency accurately reflected the pattern of hearing loss on a frequency-by-frequency basis. In most subjects, the threshold for evoking the AMFR was within 0-25 dB of hearing threshold. It therefore appears that the AMFR may be a potentially useful tool to assess hearing in those unable to undergo conventional audiometric testing.

Functioning of the brain-stem auditory pathway in non-retarded autistic individuals

Functioning of auditory brain-stem pathways was examined in non-retarded autistic individuals (14-28 years of age). Functioning was assessed by recording ERPs (event-related brain potentials) generated by these auditory pathways. These ERPs were evoked by click stimuli and occurred within the first 8 msec following the onset of the click. To assess the ability of these early auditory pathways to process sensory stimuli of varying characteristics, we systematically varied click intensity, rate of stimulation, ear of stimulation, and polarity of clicks. The results show that non-retarded autistic individuals have normal functioning of the brain-stem auditory pathways which generate these ERPs: every autistic subject had normal ERPs. So, disorder in auditory brain-stem pathways which generate these ERPs is not necessary for autism to occur. The dysfunctioning neural systems directly responsible for autism in non-retarded individuals must be sought elsewhere. Ten of the autistic subjects in this study, whom we found to have normal auditory brain-stem ERPs, had previously been found to have abnormalities in longer latency cognitive ERP components (Courchesne et al. 1984, 1985). We conclude, therefore, that those abnormalities in longer latency components are not the downstream consequences of abnormalities in the structures generating the auditory brain-stem ERPs recorded in the present study.

Early/middle evoked potentials to tone bursts in quiet, white noise and notched noise

Early/middle auditory-evoked potentials were recorded on 10 normal-hearing adults using 500-, 1 000, and 2 000-Hz tone bursts having 4-ms rise-fall and 1-ms plateau times. The stimuli were presented in quiet, white noise and notched noise at 50, 40, 30, 20 and 10 dB nHL. The noises were selected to improve frequency specificity by masking those regions of the cochlea that do not correspond to the test stimulus. The recording-amplifier system had a bandpass of 55-1 500 Hz; electric activity was measured during the 25-ms post-stimulus interval. The three waves observed during this time interval (P10, N15, and P20) were labeled to reflect polarity and latency. The results revealed no differences among stimulus conditions (quiet, white noise, notched noise) in the number of identifiable responses for any wave at any intensity. Moreover, no P10, N15 or P20 latency differences were observed among conditions at 40 dB nHL and below. When 500-Hz tone bursts were presented at 50 dB nHL, however, significantly shorter response latencies were observed in quiet than when the tone bursts were mixed with white noise or notched noise. It was concluded that frequency specificity can be improved when tone bursts are mixed with notched noise or white noise. White noise is preferred, however, because it can be implemented with less complex instrumentation and calibration than notched noise.

Comparison of the latencies between bone and air conduction in the auditory brain stem evoked potential

Brain stem auditory evoked potentials obtained by air and bone conduction were investigated in 22 subjects. The necessity for a carefully selected stimulus being presented to the headphone and the bone vibrator is discussed. Latency values of both responses are presented for wave V. Bone conduction showed latencies which were longer than those obtained by air conduction (about 0.9 msec). Possible mechanisms for this delay are discussed.

Auditory brainstem response abnormalities in autistic children

In an attempt to clarify issues of brainstem dysfunction and hearing thresholds in autistic children, we studied the Auditory Brainstem Responses (ABRs) in 32 children who clearly fit within the criteria of autism established by the National Society for Autistic Children (1977). ABRs were recorded between Cz and ipsilateral ear in response to click stimuli. Interwave latencies and auditory threshold in each ear were determined. Of the 32 children, 11 had moderate hearing loss (8 bilaterally) and 3 had severe to profound hearing loss, all bilaterally. 8 of the 14 with hearing loss also had associated features (e.g., perinatal encephalopathy). The I-III and I-V interwave latencies were significantly longer in the autistic children compared to normal control children; the increased conduction times were found mainly in the early portion of the auditory brainstem pathway. These data confirm some earlier reports of ABR abnormalities in autistic children and are concordant with some theories of the etiological basis of autism. The high incidence of hearing loss in these children is significant and routine ABR testing is recommended.

Electrophysiological investigation of the auditory system in Friedreich's ataxia

Auditory brainstem responses (ABRs) and cortical auditory evoked responses (AERs) were studied in a series of 16 Friedreich's ataxia patients who varied in age, degree of clinical involvement and duration of the disorder. The ABRs were markedly abnormal in all but the youngest patient, and the abnormalities reflected the severity and duration of the disease. The latencies of the AERs were significantly longer in the Friedreich's ataxia patients compared to normal controls, suggesting cortical as well as peripheral involvement of the auditory system. These data are discussed in terms of the neuropathology of the disorder and the similarities with the other sensory systems in Friedreich's ataxia patients.

Auditory brain stem potentials evoked by clicks in notch-filtered masking noise

Auditory brain stem evoked potentials (ABEPs) were recorded in response to wide-band clicks in notch-filtered masking noise. Notches (1/2 octave wide, 96 dB/octave slopes) were centered on the audiometric frequencies. Without the notches, masking noise intensity was adjusted to obliterate ABEPs. Intensity series, with both clicks and masking noise attenuated by the same 10 dB steps, were obtained for clicks masked by notched noise, in addition to unmasked clicks. Absolute latencies and interpeak latency differences of ABEPs to clicks in notched noise did not change with notch frequency. Absolute latencies were longer for ABEPs to clicks with notched noise than to unmasked clicks. For all stimuli, latencies were prolonged when stimulus intensity decreased. The findings suggest that ABEPs to clicks in notched noise are initiated by low threshold cochlear activation which may account for the independence of component latency from 'travelling wave' propagation time. These potentials may be representative of only one subset of the constituents of ABEPs to wide-bank unmasked clicks. The clinical application of these potentials must await elucidation of their relevance to the process of hearing.

Slow cortical responses and the diagnosis of central hearing loss in infants and young children

To evaluate the usefulness of slow cortical responses (ERA) for threshold estimation in infants and young children, 83 children were investigated with combinations of pure-tone audiometry, electrocochleography (ECochG) and ERA. The deviations between ECochG/ and ERA thresholds were correlated to brain function in order to diagnose central hearing losses. By comparing corresponding values of 2 kHz pure-tone and ERA thresholds, 32% (10/31) errors were found, mainly below 35 dB HL. In a group of patients with no sign of brain disorder, an overall error rate of 37% (20/53) was found. Below 35 dB HL, 72% (11/15) errors were found. In a group of patients with brain dysfunction, the overall rate was 70% (21/30), below 35 dB HL it was 84% (21/25). In the range below 35 dB HL, no significant difference (p greater than 0.05) in errors was found between the groups with and without brain disorders. It is concluded that ERA is unreliable for the estimation of moderate hearing losses and cannot per se detect a central hearing dysfunction. Elevated ERA thresholds may indicate a central hearing loss, but to establish this topical diagnosis, ECochG and neuropsychological examinations are necessary.

Altered objective audiometry in aminoglycosides-treated human neonates

To detect the eventual ototoxicity of aminoglycoside treatments in neonates, we compared brain stem response audiometry (BSRA) recordings in 15 neonates treated i.m. with either Gentamicin or Tobramycin at conventional dosages to those of 14 neonates used as a control group. All babies were housed in incubators and were comparable in gestational age (from 29 to 42 weeks). At day 0, BSRA did not significantly differ in the two groups, 90 dB latencies of the prominent wave V measured at 8.51 +/- 0.99 ms in the treated babies and 7.89 +/- 0.84 ms in the controls (p > 0.10), respectively. After 5 days of aminoglycoside treatment, the latencies of the wave V dwelled on 9.13 +/- 1.90 ms while remaining at 7.75 +/- 1.11 ms in the control group (p < 0.01). At day 10 latencies reached 8.73 +/- 1.47 ms in treated babies as compared t 7.31 +/- 1.06 ms in controls (p < 0.01).

Clinical status of evoked response audiometry

In the past decade there has been a widespread renewal of interest in the clinical utilization of electroencephalic responses evoked by auditory stimulation. In particular, there has been considerable research conducted on the brain stem response, the frequency following response, and the middle latency response. An overview discussion of some of the latest findings from recent and ongoing investigations is presented. Discussion is centered initially on current ideas, findings, and controversies regarding the origins or site of generation of these responses. Clinical application of the responses is discussed from two perspectives, audiologic applications and neurologic applications. Essential parameters for evoking, recording and analyzing clinically these responses are summarized. Some of the problems resulting from a lack of standardized clinical testing protocols are also mentioned. Key findings from recent clinical studies of some investigators are cited. Also recent data concerning the developmental aspects of the responses on clinical testing are included. Finally, some directions for future research on these responses are discussed. One of the latest techniques for recording and analyzing the responses and its implications for site of lesion neurologic testing are described.