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Kim JS, Brown CJ. Acoustically Evoked Compound Action Potentials Recorded From Cochlear Implant Users With Preserved Acoustic Hearing. Ear Hear 2023; 44:1061-1077. [PMID: 36882917 PMCID: PMC10440213 DOI: 10.1097/aud.0000000000001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Less traumatic intracochlear electrode design and the introduction of the soft surgery technique allow for the preservation of low-frequency acoustic hearing in many cochlear implant (CI) users. Recently, new electrophysiologic methods have also been developed that allow acoustically evoked peripheral responses to be measured in vivo from an intracochlear electrode. These recordings provide clues to the status of peripheral auditory structures. Unfortunately, responses generated from the auditory nerve (auditory nerve neurophonic [ANN]) are somewhat difficult to record because they are smaller than the hair cell responses (cochlear microphonic). Additionally, it is difficult to completely segregate the ANN from the cochlear microphonic, complicating the interpretation and limiting clinical applications. The compound action potential (CAP) is a synchronous response of multiple auditory nerve fibers and may provide an alternative to ANN where the status of the auditory nerve is of primary interest. This study is a within-subject comparison of CAPs recorded using traditional stimuli (clicks and 500 Hz tone bursts) and a new stimulus (CAP chirp). We hypothesized that the chirp stimulus might result in a more robust CAP than that recorded using traditional stimuli, allowing for a more accurate assessment of the status of the auditory nerve. DESIGN Nineteen adult Nucleus L24 Hybrid CI users with residual low-frequency hearing participated in this study. CAP responses were recorded from the most apical intracochlear electrode using a 100 μs click, 500 Hz tone bursts, and chirp stimuli presented via the insert phone to the implanted ear. The chirp stimulus used in this study was CAP chirp generated using parameters from human-derived band CAPs ( Chertoff et al. 2010 ). Additionally, nine custom chirps were created by systematically varying the frequency sweep rate of the power function used to construct the standard CAP chirp stimulus. CAPs were recorded using all acoustic stimuli, allowing for within-subject comparisons of the CAP amplitude, threshold, percentage of measurable CAP responses, and waveform morphology. RESULTS Considerable variation in response morphology was apparent across stimuli and stimulation levels. Clicks and CAP chirp significantly evoked identifiable CAP response more compared to 500 Hz tone bursts. At relatively high stimulation levels, the chirp-evoked CAPs were significantly larger in amplitude and less ambiguous in morphology than the click-evoked CAPs. The status of residual acoustic hearing at high frequencies influenced the likelihood that a CAP could be reliably recorded. Subjects with better preserved hearing at high frequencies had significantly larger CAP amplitudes when CAP chirp was used. Customizing the chirp stimulus by varying the frequency sweep rates significantly affected the CAP amplitudes; however, pairwise comparisons did not show significant differences between chirps. CONCLUSIONS CAPs can be measured more effectively using broadband acoustic stimuli than 500 Hz tone bursts in CI users with residual low-frequency acoustic hearing. The advantage of using CAP chirp stimulus relative to standard clicks is dependent on the extent of preserved acoustic hearing at high frequencies and the stimulus level. The chirp stimulus may present an attractive alternative to standard clicks or tone bursts for this CI population when the goal is to record robust CAP responses.
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Affiliation(s)
- Jeong-Seo Kim
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Hearing Research Laboratory, Samsung Medical Center, Seoul, South Korea
- Medical Research Institute, Sungkyunkwan University, Suwon, South Korea
| | - Carolyn J. Brown
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Mattiazzi ÂL, Cóser PL, Endruweit Battisti ID, Pinto JD, Pinto Vieira Biaggio E. Auditory Brainstem response electrophysiological thresholds with narrow band chirps stimuli in hearing infants. Int J Pediatr Otorhinolaryngol 2023; 164:111417. [PMID: 36525696 DOI: 10.1016/j.ijporl.2022.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES to describe reference values for the electrophysiological thresholds obtained in the frequency-specific Auditory Brainstem Response (fsABR) with the NB CE-Chirp® LS and NB iChirp stimuli in hearing infants and to compare the variables: Minimum Levels of Response (MLR), latency, amplitude and examination time. METHODS the sample consisted of 74 full-term infants, with a mean age of 23.11 days, 29 females and 45 males. The participants underwent fsABR at the frequencies of 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz, to measure the MLR with the NB CE-Chirp® LS stimulus in the Eclipse equipment, and with the NB iChirp stimulus in the SmartEP, all in natural sleep and performed in the same session. The waveforms were evaluated by judges and later, for the comparison of thresholds and examination time, analyzed with the Wilcoxon test. To compare latency and amplitude, the Student's T Test and ANOVA were used for the same variables, but with the same stimulus. The Kruskal-Wallis test was used to compare the examination time at the different frequencies. RESULTS The MLR and latency at 500 Hz and 1000 Hz showed a statistically significant difference between the stimuli, with lower thresholds and higher latencies for the NB iChirp. Higher amplitudes were obtained with the NB iChirp stimulus. The average examination time for the threshold investigation in the four frequencies was 40 min for each ear. CONCLUSION it was possible to present reference values for the MLR and latencies for the NB CE-Chirp® LS and NB iChirp stimuli for hearing infants. In addition, with the NB iChirp, the latency of the responses was influenced by the frequency, but it was the stimulus that provided greater amplitudes. With the NB CE-Chirp® LS, the frequency did not influence latency, except at 500 Hz, and the stimulus provided recordings that facilitated the visualization of wave V. There was no difference in the examination time between the stimuli, nor between the test frequencies.
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Affiliation(s)
| | | | | | - Julia Dalcin Pinto
- Speech Therapy Department, Federal University of Santa Maria, Santa Maria, Brazil
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Objektive frequenzspezifische Hörschwellenbestimmung mittels schmalbandiger Chirp-Reize mit pegeladaptiver simultaner Maskierung. HNO 2019; 67:843-854. [DOI: 10.1007/s00106-019-0676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cobb KM, Stuart A. Neonate Auditory Brainstem Responses to CE-Chirp and CE-Chirp Octave Band Stimuli I: Versus Click and Tone Burst Stimuli. Ear Hear 2016; 37:710-723. [DOI: 10.1097/aud.0000000000000343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neonate Auditory Brainstem Responses to CE-Chirp and CE-Chirp Octave Band Stimuli II: Versus Adult Auditory Brainstem Responses. Ear Hear 2016; 37:724-743. [PMID: 27556524 DOI: 10.1097/aud.0000000000000344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of the study was to examine the differences in auditory brainstem response (ABR) latency and amplitude indices to the CE-Chirp stimuli in neonates versus young adults as a function of stimulus level, rate, polarity, frequency and gender. DESIGN Participants were 168 healthy neonates and 20 normal-hearing young adults. ABRs were obtained to air- and bone-conducted CE-Chirps and air-conducted CE-Chirp octave band stimuli. The effects of stimulus level, rate, and polarity were examined with air-conducted CE-Chirps. The effect of stimulus level was also examined with bone-conducted CE-Chirps and CE-Chirp octave band stimuli. The effect of gender was examined across all stimulus manipulations. RESULTS In general, ABR wave V amplitudes were significantly larger (p < 0.0001) and latencies were significantly shorter (p < 0.0001) for adults versus neonates for all air-conducted CE-Chirp stimuli with all stimulus manipulations. For bone-conducted CE-Chirps, infants had significantly shorter wave V latencies than adults at 15 dB nHL and 45 dB nHL (p = 0.02). Adult wave V amplitude was significantly larger for bone-conducted CE-Chirps only at 30 dB nHL (p = 0.02). The effect of gender was not statistically significant across all measures (p > 0.05). CONCLUSIONS Significant differences in ABR latencies and amplitudes exist between newborns and young adults using CE-Chirp stimuli. These differences are consistent with differences to traditional click and tone burst stimuli and reflect maturational differences as a function of age. These findings continue to emphasize the importance of interpreting ABR results using age-based normative data.
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Otsuka A, Yumoto M, Kuriki S, Hotehama T, Nakagawa S. Frequency characteristics of neuromagnetic auditory steady-state responses to sinusoidally amplitude-modulated sweep tones. Clin Neurophysiol 2015; 127:790-802. [PMID: 26162292 DOI: 10.1016/j.clinph.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/08/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to capture the neuronal frequency characteristics, as indexed by the auditory steady-state response (ASSR), relative to physical characteristics of constant sound pressure levels (SPLs). Relationship with perceptual characteristics (loudness model) was also examined. METHODS Neuromagnetic 40-Hz ASSR was recorded in response to sinusoidally amplitude-modulated sweep tones with carrier frequency covering the frequency range of 0.1-12.5kHz. Sound intensity was equalized at 50-, 60-, and 70-dB SPL with an accuracy of ±0.5-dB SPL at the phasic peak of the modulation frequency. Corresponding loudness characteristics were modeled by substituting the detected individual hearing thresholds into a standard formula (ISO226:2003(E)). RESULTS The strength of the ASSR component was maximum at 0.5kHz, and it decreased linearly on logarithmic scale toward lower and higher frequencies. Loudness model was plateaued between 0.5 and 4kHz. CONCLUSIONS Frequency characteristics of the ASSR were not equivalent to those of SPL and loudness model. Factors other than physical and perceptual frequency characteristics may contribute to characterizing the ASSR. SIGNIFICANCE The results contribute to the discussion of the most efficient signal summation for the generation of the ASSR at 0.5kHz and efficient neuronal processing at higher frequencies, which require less energy to retain equal perception.
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Affiliation(s)
- Asuka Otsuka
- Biomedical Research Institute, The National Institute of Advanced Industrial Science and Technology (AIST), Osaka, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Yumoto
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Kuriki
- Research Center for Science and Technology, Tokyo Denki University, Chiba, Japan
| | - Takuya Hotehama
- Biomedical Research Institute, The National Institute of Advanced Industrial Science and Technology (AIST), Osaka, Japan
| | - Seiji Nakagawa
- Biomedical Research Institute, The National Institute of Advanced Industrial Science and Technology (AIST), Osaka, Japan.
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Zirn S, Louza J, Reiman V, Wittlinger N, Hempel JM, Schuster M. Comparison between ABR with click and narrow band chirp stimuli in children. Int J Pediatr Otorhinolaryngol 2014; 78:1352-5. [PMID: 24882456 DOI: 10.1016/j.ijporl.2014.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Click and chirp-evoked auditory brainstem responses (ABR) are applied for the estimation of hearing thresholds in children. The present study analyzes ABR thresholds across a large sample of children's ears obtained with both methods. The aim was to demonstrate the correlation between both methods using narrow band chirp and click stimuli. METHODS Click and chirp evoked ABRs were measured in 253 children aged from 0 to 18 years to determine their individual auditory threshold. The delay-compensated stimuli were narrow band CE chirps with either 2000 Hz or 4000 Hz center frequencies. Measurements were performed consecutively during natural sleep, and under sedation or general anesthesia. Threshold estimation was performed for each measurement by two experienced audiologists. RESULTS Pearson-correlation analysis revealed highly significant correlations (r=0.94) between click and chirp derived thresholds for both 2 kHz and 4 kHz chirps. No considerable differences were observed either between different age ranges or gender. Comparing the thresholds estimated using ABR with click stimuli and chirp stimuli, only 0.8-2% for the 2000 Hz NB-chirp and 0.4-1.2% of the 4000 Hz NB-chirp measurements differed more than 15 dB for different degrees of hearing loss or normal hearing. CONCLUSION The results suggest that either NB-chirp or click ABR is sufficient for threshold estimation. This holds for the chirp frequencies of 2000 Hz and 4000 Hz. The use of either click- or chirp-evoked ABR allows a reduction of recording time in young infants. Nevertheless, to cross-check the results of one of the methods, we recommend measurements with the other method as well.
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Affiliation(s)
- Stefan Zirn
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany
| | - Julia Louza
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany
| | - Viktor Reiman
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany
| | - Natalie Wittlinger
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany
| | - John-Martin Hempel
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany
| | - Maria Schuster
- University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, Marchioninistr 15, Munich D-81377, Germany.
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Valderrama JT, de la Torre A, Alvarez I, Segura JC, Thornton ARD, Sainz M, Vargas JL. Automatic quality assessment and peak identification of auditory brainstem responses with fitted parametric peaks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 114:262-75. [PMID: 24661606 DOI: 10.1016/j.cmpb.2014.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/22/2014] [Accepted: 02/25/2014] [Indexed: 05/17/2023]
Abstract
The recording of the auditory brainstem response (ABR) is used worldwide for hearing screening purposes. In this process, a precise estimation of the most relevant components is essential for an accurate interpretation of these signals. This evaluation is usually carried out subjectively by an audiologist. However, the use of automatic methods for this purpose is being encouraged nowadays in order to reduce human evaluation biases and ensure uniformity among test conditions, patients, and screening personnel. This article describes a new method that performs automatic quality assessment and identification of the peaks, the fitted parametric peaks (FPP). This method is based on the use of synthesized peaks that are adjusted to the ABR response. The FPP is validated, on one hand, by an analysis of amplitudes and latencies measured manually by an audiologist and automatically by the FPP method in ABR signals recorded at different stimulation rates; and on the other hand, contrasting the performance of the FPP method with the automatic evaluation techniques based on the correlation coefficient, FSP, and cross correlation with a predefined template waveform by comparing the automatic evaluations of the quality of these methods with subjective evaluations provided by five experienced evaluators on a set of ABR signals of different quality. The results of this study suggest (a) that the FPP method can be used to provide an accurate parameterization of the peaks in terms of amplitude, latency, and width, and (b) that the FPP remains as the method that best approaches the averaged subjective quality evaluation, as well as provides the best results in terms of sensitivity and specificity in ABR signals validation. The significance of these findings and the clinical value of the FPP method are highlighted on this paper.
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Affiliation(s)
- Joaquin T Valderrama
- Department of Signal Theory, Telematics and Communications, CITIC-UGR, University of Granada, C/Periodista Daniel Saucedo Aranda s/n, 18071 Granada, Spain.
| | - Angel de la Torre
- Department of Signal Theory, Telematics and Communications, CITIC-UGR, University of Granada, C/Periodista Daniel Saucedo Aranda s/n, 18071 Granada, Spain.
| | - Isaac Alvarez
- Department of Signal Theory, Telematics and Communications, CITIC-UGR, University of Granada, C/Periodista Daniel Saucedo Aranda s/n, 18071 Granada, Spain.
| | - Jose Carlos Segura
- Department of Signal Theory, Telematics and Communications, CITIC-UGR, University of Granada, C/Periodista Daniel Saucedo Aranda s/n, 18071 Granada, Spain.
| | - A Roger D Thornton
- MRC Institute of Hearing Research, Southampton Outstation, Royal South Hants Hospital, Brintons Terrace, Mailpoint OAU, Southampton, Hampshire SO14 OYG, United Kingdom.
| | - Manuel Sainz
- ENT Service, San Cecilio University Hospital, Av. Dr. Oloriz 16, 18002 Granada, Spain; Department of Surgery and its Specialties, University of Granada, Av. De Madrid 11, 18012 Granada, Spain.
| | - Jose Luis Vargas
- ENT Service, San Cecilio University Hospital, Av. Dr. Oloriz 16, 18002 Granada, Spain.
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Wojtczak M, Beim JA, Micheyl C, Oxenham AJ. Effects of temporal stimulus properties on the perception of across-frequency asynchrony. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2013; 133:982-997. [PMID: 23363115 PMCID: PMC3574076 DOI: 10.1121/1.4773350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 11/24/2012] [Accepted: 12/11/2012] [Indexed: 06/01/2023]
Abstract
The role of temporal stimulus parameters in the perception of across-frequency synchrony and asynchrony was investigated using pairs of 500-ms tones consisting of a 250-Hz tone and a tone with a higher frequency of 1, 2, 4, or 6 kHz. Subjective judgments suggested veridical perception of across-frequency synchrony but with greater sensitivity to changes in asynchrony for pairs in which the lower-frequency tone was leading than for pairs in which it was lagging. Consistent with the subjective judgments, thresholds for the detection of asynchrony measured in a three-alternative forced-choice task were lower when the signal interval contained a pair with the low-frequency tone leading than a pair with a high-frequency tone leading. A similar asymmetry was observed for asynchrony discrimination when the standard asynchrony was relatively small (≤20 ms) but not for larger standard asynchronies. Independent manipulation of onset and offset ramp durations indicated a dominant role of onsets in the perception of across-frequency asynchrony. A physiologically inspired model, involving broadly tuned monaural coincidence detectors that receive inputs from frequency-selective onset detectors, was able to accurately reproduce the asymmetric distributions of synchrony judgments. The model provides testable predictions for future physiological investigations of responses to broadband stimuli with across-frequency delays.
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Affiliation(s)
- Magdalena Wojtczak
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, Minnesota 55455, USA.
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Elberling C, Kristensen SGB, Don M. Auditory brainstem responses to chirps delivered by different insert earphones. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2012; 131:2091-100. [PMID: 22423705 PMCID: PMC3316682 DOI: 10.1121/1.3677257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The frequency response and sensitivity of the ER-3A and ER-2 insert earphones are measured in the occluded-ear simulator using three ear canal extensions. Compared to the other two extensions, the DB 0370 (Brüel & Kjær), which is recommended by the international standards, introduces a significant resonance peak around 4500 Hz. The ER-3A has an amplitude response like a band-pass filter (1400 Hz, 6 dB/octave -4000 Hz, -36 dB/octave), and a group delay with "ripples" of up to ±0.5 ms, while the ER-2 has an amplitude response, and a group delay which are flat and smooth up to above 10000 Hz. Both earphones are used to record auditory brainstem responses, ABRs, from 22 normal-hearing ears in response to two chirps and a click at levels from 20 to 80 dB nHL. While the click-ABRs are slightly larger for ER-2 than for ER-3A, the chirp-ABRs are much larger for ER-2 than for ER-3A at levels below 60 dB nHL. With a simulated amplitude response of the ER-3A and the smooth group delay of the ER-2 it is shown that the increased chirp-ABR amplitude with the ER-2 is caused by its broader amplitude response and not by its smoother group delay.
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Affiliation(s)
- Claus Elberling
- William Demant Holding A/S, Kongebakken 9, DK-2765 Smørum, Denmark.
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Wojtczak M, Beim JA, Micheyl C, Oxenham AJ. Perception of across-frequency asynchrony and the role of cochlear delays. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2012; 131:363-377. [PMID: 22280598 PMCID: PMC3272712 DOI: 10.1121/1.3665995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 05/29/2023]
Abstract
Cochlear filtering results in earlier responses to high than to low frequencies. This study examined potential perceptual correlates of cochlear delays by measuring the perception of relative timing between tones of different frequencies. A brief 250-Hz tone was combined with a brief 1-, 2-, 4-, or 6-kHz tone. Two experiments were performed, one involving subjective judgments of perceived synchrony, the other involving asynchrony detection and discrimination. The functions relating the proportion of "synchronous" responses to the delay between the tones were similar for all tone pairs. Perceived synchrony was maximal when the tones in a pair were gated synchronously. The perceived-synchrony function slopes were asymmetric, being steeper on the low-frequency-leading side. In the second experiment, asynchrony-detection thresholds were lower for low-frequency rather than for high-frequency leading pairs. In contrast with previous studies, but consistent with the first experiment, thresholds did not depend on frequency separation between the tones, perhaps because of the elimination of within-channel cues. The results of the two experiments were related quantitatively using a decision-theoretic model, and were found to be highly correlated. Overall the results suggest that frequency-dependent cochlear group delays are compensated for at higher processing stages, resulting in veridical perception of timing relationships across frequency.
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Affiliation(s)
- Magdalena Wojtczak
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, Minnesota 55455, USA.
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Presbycusis and auditory brainstem responses: a review. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60056-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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