Binaural interaction in human neonatal auditory brainstem

Electrophysiological Screening for Children With Suspected Auditory Processing Disorder: A Systematic Review

Objective: This research aimed to provide evidence for the early identification and intervention of children at risk for auditory processing disorder (APD). Electrophysiological studies on children with suspected APDs were systematically reviewed to understand the different electrophysiological characteristics of children with suspected APDs. Methods: Computerized databases such as PubMed, Cochrane, MEDLINE, Web of Science, and EMBASE were searched for retrieval of articles since the establishment of the database through May 18, 2020. Cohort, case-control, and cross-sectional studies that evaluated the literature for the electrophysiological assessment of children with suspected APD were independently reviewed by two researchers for literature screening, literature quality assessment, and data extraction. The Newcastle-Ottawa Scale and 11 entries recommended by the Agency for Healthcare Research and Quality were used to evaluate the quality of the literature. Results: In accordance with the inclusion criteria, 14 articles were included. These articles involved 7 electrophysiological testing techniques: click-evoked auditory brainstem responses, frequency-following responses, the binaural interaction component of the auditory brainstem responses, the middle-latency response, cortical auditory evoked potential, mismatch negativity, and P300. The literature quality was considered moderate. Conclusions: Auditory electrophysiological testing can be used for the characteristic identification of children with suspected APD; however, the value of various electrophysiological testing methods for screening children with suspected APD requires further study.

Normative Study of the Binaural Interaction Component of the Human Auditory Brainstem Response as a Function of Interaural Time Differences

OBJECTIVES

The binaural interaction component (BIC) of the auditory brainstem response (ABR) is obtained by subtracting the sum of the monaural right and left ear ABRs from the binaurally evoked ABR. The result is a small but prominent negative peak (herein called "DN1"), indicating a smaller binaural than summed ABR, which occurs around the latency of wave V or its roll-off slope. The BIC has been proposed to have diagnostic value as a biomarker of binaural processing abilities; however, there have been conflicting reports regarding the reliability of BIC measures in human subjects. The objectives of the current study were to: (1) examine prevalence of BIC across a large group of normal-hearing young adults; (2) determine effects of interaural time differences (ITDs) on BIC; and (3) examine any relationship between BIC and behavioral ITD discrimination acuity.

DESIGN

Subjects were 40 normal-hearing adults (20 males and 20 females), aged 21 to 48 years, with no history of otologic or neurologic disorders. Midline ABRs were recorded from electrodes at high forehead (Fz) referenced to the nape of the neck (near the seventh cervical vertebra), with Fpz (low forehead) as the ground. ABRs were also recorded with a conventional earlobe reference for comparison to midline results. Stimuli were 90 dB peSPL biphasic clicks. For BIC measurements, stimuli were presented in a block as interleaved right monaural, left monaural, and binaural stimuli with 2000+ presentations per condition. Four measurements were averaged for a total of 8000+ stimuli per analyzed waveform. BIC was measured for ITD = 0 (simultaneous bilateral) and for ITDs of ±500 and ±750 µs. Subjects separately performed a lateralization task, using the same stimuli, to determine ITD discrimination thresholds.

RESULTS

An identifiable BIC DN1 was obtained in 39 of 40 subjects at ITD = 0 µs in at least one of two measurement sessions, but was seen in lesser numbers of subjects in a single session or as ITD increased. BIC was most often seen when a subject was relaxed or sleeping, and less often when they fidgeted or reported neck tension, suggesting myogenic activity as a possible factor in disrupting BIC measurements. Mean BIC latencies systematically increased with increasing ITD, and mean BIC amplitudes tended to decrease. However, across subjects, there was no significant relationship between the amplitude or latency of the BIC and behavioral ITD thresholds.

CONCLUSIONS

Consistent with previous studies, measurement of the BIC was time consuming and a BIC was sometimes difficult to obtain in awake normal-hearing subjects. The BIC will thus continue to be of limited clinical utility unless stimulus parameters and measurement techniques can be identified that produce a more robust response. Nonetheless, modulation of BIC characteristics by ITD supports the concept that the ABR BIC indexes aspects of binaural brainstem processing and thus may prove useful in selected research applications, e.g. in the examination of populations expected to have aberrant binaural signal processing ability.

Across Species "Natural Ablation" Reveals the Brainstem Source of a Noninvasive Biomarker of Binaural Hearing

The binaural interaction component (BIC) of the auditory brainstem response is a noninvasive electroencephalographic signature of neural processing of binaural sounds. Despite its potential as a clinical biomarker, the neural structures and mechanism that generate the BIC are not known. We explore here the hypothesis that the BIC emerges from excitatory-inhibitory interactions in auditory brainstem neurons. We measured the BIC in response to click stimuli while varying interaural time differences (ITDs) in subjects of either sex from five animal species. Species had head sizes spanning a 3.5-fold range and correspondingly large variations in the sizes of the auditory brainstem nuclei known to process binaural sounds [the medial superior olive (MSO) and the lateral superior olive (LSO)]. The BIC was reliably elicited in all species, including those that have small or inexistent MSOs. In addition, the range of ITDs where BIC was elicited was independent of animal species, suggesting that the BIC is not a reflection of the processing of ITDs per se. Finally, we provide a model of the amplitude and latency of the BIC peak, which is based on excitatory-inhibitory synaptic interactions, without assuming any specific arrangement of delay lines. Our results show that the BIC is preserved across species ranging from mice to humans. We argue that this is the result of generic excitatory-inhibitory synaptic interactions at the level of the LSO, and thus best seen as reflecting the integration of binaural inputs as opposed to their spatial properties.SIGNIFICANCE STATEMENT Noninvasive electrophysiological measures of sensory system activity are critical for the objective clinical diagnosis of human sensory processing deficits. The binaural component of sound-evoked auditory brainstem responses is one such measure of binaural auditory coding fidelity in the early stages of the auditory system. Yet, the precise neurons that lead to this evoked potential are not fully understood. This paper provides a comparative study of this potential in different mammals and shows that it is preserved across species, from mice to men, despite large variations in morphology and neuroanatomy. Our results confirm its relevance to the assessment of binaural hearing integrity in humans and demonstrates how it can be used to bridge the gap between rodent models and humans.

The effect of interaural timing on the posterior auricular muscle reflex in normal adult volunteers

The posterior auricular muscle (PAM) reflex to sounds has been used clinically to determine hearing threshold as an alternative to other audiological diagnostic measures such as the auditory brainstem response. We have shown that the PAM response is also sensitive to interaural timing differences in normally hearing adults. PAM responses were evoked by both ipsilateral/ contralateral monaural stimulation and by binaural stimulation. Introducing sound delays ipsilaterally or contralaterally decreased the PAM response amplitude and increased its latency. The PAM response in this study shows a qualitatively similar pattern to that seen by the binaural interaction component (BIC) of the auditory brainstem potential to binaural clicks described in previous studies, in that both: have their shortest latency and maximal amplitudes centred around zero interaural timing differences, have response latencies increase with increasing interaural delays up to 1.2 ms and have response amplitudes decrease with increasing interaural delays of up to 1.2 ms. Our data show that the PAM response may be useful in measuring binaural integration in humans non-invasively for diagnostic or research studies.

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.

Test-Retest Reliability of the Binaural Interaction Component of the Auditory Brainstem Response

OBJECTIVES

The binaural interaction component (BIC) is the residual auditory brainstem response (ABR) obtained after subtracting the sum of monaurally evoked from binaurally evoked ABRs. The DN1 peak-the first negative peak of the BIC-has been postulated to have diagnostic value as a biomarker for binaural hearing abilities. Indeed, not only do DN1 amplitudes depend systematically upon binaural cues to location (interaural time and level differences), but they are also predictive of central hearing deficits in humans. A prominent issue in using BIC measures as a diagnostic biomarker is that DN1 amplitudes not only exhibit considerable variability across subjects, but also within subjects across different measurement sessions.

DESIGN

In this study, the authors investigate the DN1 amplitude measurement reliability by conducting repeated measurements on different days in eight adult guinea pigs.

RESULTS

Despite consistent ABR thresholds, ABR and DN1 amplitudes varied between and within subjects across recording sessions. However, the study analysis reveals that DN1 amplitudes varied proportionally with parent monaural ABR amplitudes, suggesting that common experimental factors likely account for the variability in both waveforms. Despite this variability, the authors show that the shape of the dependence between DN1 amplitude and interaural time difference is preserved. The authors then provide a BIC normalization strategy using monaural ABR amplitude that reduces the variability of DN1 peak measurements. Finally, the authors evaluate this normalization strategy in the context of detecting changes of the DN1 amplitude-to-interaural time difference relationship.

CONCLUSIONS

The study results indicate that the BIC measurement variability can be reduced by a factor of two by performing a simple and objective normalization operation. The authors discuss the potential for this normalized BIC measure as a biomarker for binaural hearing.

Staring us in the face? An embodied theory of innate face preference

Human expertise in face perception grows over development, but even within minutes of birth, infants exhibit an extraordinary sensitivity to face-like stimuli. The dominant theory accounts for innate face detection by proposing that the neonate brain contains an innate face detection device, dubbed 'Conspec'. Newborn face preference has been promoted as some of the strongest evidence for innate knowledge, and forms a canonical stage for the modern form of the nature-nurture debate in psychology. Interpretation of newborn face preference results has concentrated on monocular stimulus properties, with little mention or focused investigation of potential binocular involvement. However, the question of whether and how newborns integrate the binocular visual streams bears directly on the generation of observable visual preferences. In this theoretical paper, we employ a synthetic approach utilizing robotic and computational models to draw together the threads of binocular integration and face preference in newborns, and demonstrate cases where the former may explain the latter. We suggest that a system-level view considering the binocular embodiment of newborn vision may offer a mutually satisfying resolution to some long-running arguments in the polarizing debate surrounding the existence and causal structure of newborns' 'innate knowledge' of faces.

Bilateral gain control; an "innate predisposition" for all sorts of things

Empirical studies have revealed remarkable perceptual organization in neonates. Newborn behavioral distinctions have often been interpreted as implying functionally specific modular adaptations, and are widely cited as evidence supporting the nativist agenda. In this theoretical paper, we approach newborn perception and attention from an embodied, developmental perspective. At the mechanistic level, we argue that a generative mechanism based on mutual gain control between bilaterally corresponding points may underly a number of functionally defined “innate predispositions” related to spatial-configural perception. At the computational level, bilateral gain control implements beamforming, which enables spatial-configural tuning at the front end sampling stage. At the psychophysical level, we predict that selective attention in newborns will favor contrast energy which projects to bilaterally corresponding points on the neonate subject's sensor array. The current work extends and generalizes previous work to formalize the bilateral correlation model of newborn attention at a high level, and demonstrate in minimal agent-based simulations how bilateral gain control can enable a simple, robust and “social” attentional bias.

Binaural interactions develop in the auditory brainstem of children who are deaf: effects of place and level of bilateral electrical stimulation

Bilateral cochlear implants (CIs) might promote development of binaural hearing required to localize sound sources and hear speech in noise for children who are deaf. These hearing skills improve in children implanted bilaterally but remain poorer than normal. We thus questioned whether the deaf and immature human auditory system is able to integrate input delivered from bilateral CIs. Using electrophysiological measures of brainstem activity that include the Binaural Difference (BD), a measure of binaural processing, we showed that a period of unilateral deprivation before bilateral CI use prolonged response latencies but that amplitudes were not significantly affected. Tonotopic organization was retained to some extent as evidenced by an elimination of the BD with large mismatches in place of stimulation between the two CIs. Smaller place mismatches did not affect BD latency or amplitude, indicating that the tonotopic organization of the auditory brainstem is underdeveloped and/or not well used by CI stimulation. Finally, BD amplitudes decreased when the intensity of bilateral stimulation became weighted to one side and this corresponded to a perceptual shift of sound away from midline toward the side of increased intensity. In summary, bilateral CI stimulation is processed by the developing human auditory brainstem leading to perceptual changes in sound location and potentially improving hearing for children who are deaf.

Effects of stimulation level and electrode pairing on the binaural interaction component of the electrically evoked auditory brain stem response

OBJECTIVES

The purpose of this study was to investigate the effects of stimulation level and electrode pairing on the binaural interaction component (BIC) of the electrically evoked auditory brain stem response (EABR) in Nucleus cochlear implant (CI) users.

DESIGN

Ten postlingually deafened adult CI users participated in this study. EABRs were measured using loudness balanced, biphasic current pulses presented in the left monaural, right monaural, and bilateral stimulation conditions. BICs were computed based on measures of the EABR obtained for each subject by pairing the electrode 12 (of 22 intracochlear electrodes) in the right ear with each of 11 electrodes spaced across the electrode array in the left ear. The effect of stimulation level on the amplitude of the BIC was investigated by measuring growth functions of the BIC from six subjects. The effect of electrode pairing on the amplitude of the BIC was studied at high stimulation levels in 10 subjects and at low stimulation levels in seven subjects. The high stimulation level was chosen as the 90% point of the subject's dynamic range (DR) or the highest stimulation level in which the electrophysiologic recordings were not contaminated by muscle artifacts. The low stimulation level was chosen as a level that was 10% point of subject's DR higher than the BIC threshold for six of these seven subjects. For one subject, BIC thresholds were not available and the low stimulation level was referred to the 70% point of subject's DR.

RESULTS

BICs were successfully recorded from all 11 interaural electrode pairs for a majority of subjects tested at both stimulation levels. BIC amplitudes increased with stimulation level. The effect of stimulation level on latencies of the BIC was less robust. At high stimulation levels, BIC amplitudes did not change significantly as the stimulating electrode used in the left ear was systematically varied. When low stimulation levels were used, BIC amplitude was maximal for interaural electrode pairs with similar intracochlear positions and decreased when the offset between interaural electrodes increased.

CONCLUSIONS

This study demonstrates that stimulation level affects amplitudes of the BIC response. It is possible to record the BIC of the EABR in bilateral CI users even from interaural electrode pairs that have large interaural offsets. This finding suggests that when high-level stimuli are used, there is a broad pattern of current spread within the two cochleae. At lower stimulation levels, the spread of excitation within the cochlea is reduced making the effect of electrode pairing on the amplitude of the BIC more pronounced.

A time-frequency feature extraction scheme for the automated detection of binaural interaction in auditory brainstem responses

The binaural interaction component (BIC), the difference between the summed monaurally evoked potentials of each ear and the binaurally evoked brainstem potentials, has been shown to be related to directional hearing. However, the detection of the beta-peak as the most consistent part of the BIC is often difficult. Furthermore, there is no clearly defined signal feature characterizing the difference between the monaurally and the binaurally evoked brainstem responses. A closer look at the signals shows that amplitude differences as well as latency differences and variations in wave V slopes could be the reason for the formation of a beta-peak. Using a time-scale feature extraction scheme, we were able to define a signal feature (morphological local discriminant bases (MLDB) coefficient 1) that accounts for the difference between the sum of the monaurally and binaurally evoked brainstem potentials. With use of this signal feature, reliable automated detection of differences between monaurally and binaurally evoked potentials is possible. As coefficient 1 replicates the behaviour of subjective measurements as well as of the BIC measurements, it can also be seen as a correlate of binaural interaction. With use of this signal feature, it is possible to judge from a given binaurally evoked potential whether it contains information on binaural interaction or not, without comparing it to the sum of the monaurally evoked brainstem responses Consequently, binaural interaction can be assessed by one, instead of three, measurements by using the method described in this paper.

Binaural processing in children using bilateral cochlear implants

Binaural auditory brainstem processing was examined using evoked potential measures in 40 children who were implanted early and received a second implant simultaneously or after long or short periods of unilateral implant use. Wave latencies were shorter when evoked by the experienced versus naïve implanted ear at initial bilateral activation. Binaural difference waves were detected in most children in response to apical but not basal electrode stimulation and were prolonged in latency in children implanted after long or short delays between implants. Timing differences between the implanted ears in children receiving sequential but not simultaneous bilateral implants reflect a relative immaturity of pathways innervating the second ear and results in abnormal timing of binaural processing at this initial implant stage.

Brain-stem auditory impairment during the neonatal period in term infants after asphyxia: dynamic changes in brain-stem auditory evoked response to clicks of different rates

OBJECTIVE

To explore dynamic changes in brain-stem auditory electrophysiology during the neonatal period in term infants after perinatal asphyxia.

METHODS

Sixty-eight term newborn infants who suffered asphyxia were studied on days 1, 3, 5, 7, 14 and 30 after birth. Brain-stem auditory evoked response (BAER) was recorded with clicks, delivered at 21, 51 and 91 s(-1) and > or =40 dB above BAER threshold of each subject.

RESULTS

During the neonatal period wave I latency in the infants after asphyxia increased slightly while later BAER components changed more significantly. On the first day after birth wave III and V latencies and I-V and III-V intervals increased significantly at all rates of clicks (ANOVA P<0.01-0.001). On day 3, the latencies and intervals increased further. III-V/I-III interval ratio increased at 51 and 91 s(-1), suggesting a relatively more significant increase in III-V interval than in I-III interval at higher rates. Thereafter, wave III and V latencies and all intervals decreased progressively, although these BAER variables were still significantly longer than in normal controls on days 5 and 7 (P<0.05-0.001) On day 30, all latencies and intervals approached near normal values, with a slight increase in wave V latency and I-V and III-V intervals at 51 and 91 s(-1).

CONCLUSIONS

Perinatal asphyxia has a major effect on central auditory function, resulting in acute impairment. The impairment progresses during the first 3 days and then tends towards recovery. By 1 month the impaired auditory function has largely returned to normal. Significant increase in click rates can moderately improve the detection of auditory impairment.

SIGNIFICANCE

After perinatal asphyxia early detection of hypoxic-ischaemic damage to the central auditory system and initialisation of neuroprotective and therapeutic measures during the first hours after birth are critical to prevent or reduce deterioration of central impairment.

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.

Maximum length sequence brainstem auditory evoked responses in term neonates who have perinatal hypoxia-ischemia

Maximum length sequence brainstem auditory evoked response (BAER) was studied within the first week after birth in 28 term neonates who had perinatal hypoxia-ischemia, or asphyxia. In the BAER recorded using conventional averaging techniques (click rate 21/s), the only abnormality was a slight increase in III-V interval, in addition to an increase in wave latencies when including those who had an elevated threshold (t test, all p<0.05). In the maximum length sequence BAER, however, both the III-V and I-V intervals in the asphyxiated infants were significantly increased at all the 91/s, 227/s, 455/s, and particularly 910/s click rates (p<0.05-0.001). The I-III interval was also increased significantly at 455/s and 910/s click rates (both p< 0.05). Wave V amplitude was significantly reduced at all the click rates used (ANOVA, p<0.05-0.001), particularly at 910/s, which sometimes was the only abnormality indicative of brain damage. Both the amplitude ratios V/I and V/III were significantly decreased at 455/s and 910/s click rates (p<0.01 or 0.001). A general trend was that BAER abnormalities after hypoxia-ischemia became more prominent as click rate was increased. Significant abnormalities occurred mainly at very high click rates (455/s and 910/s), which can be achieved using the maximum length sequence technique but not by using conventional averaging techniques. Thus, this technique, which can be used at the cribside, appears to be a better method for the early detection of brain damage after hypoxia-ischemia than using conventional averaging techniques, enhancing the diagnostic value of the BAER.

Binaural interaction component in children at risk for central auditory processing disorders

The binaural interaction component (BIC) occurring in the latency range of peak V of the auditory brainstem responses (ABR) was investigated in nine normal children, comprising the control group, and nine children at risk for central auditory processing disorders (CAPD), comprising the CAPD group. All children tested had normal hearing, normal intelligence and normal ABR thresholds. Averaged BIC obtained from the difference between the summed and binaural ABR waveforms was compared between the two groups for amplitude and latency measures. Results indicated a significant reduction in the amplitude of the BIC occurring in the latency domain of ABR peak V, in the CAPD group.

Slope analysis of Auditory Brainstem Responses in children at risk of central auditory processing disorders

The method of slope vectors was used to quantify Auditory Brainstem Responses (ABR) obtained from nine normal children and nine children at risk for central auditory processing disorders (CAPD) with language impairment, for monaural and binaural stimulation conditions. Slopes thus obtained were subjected to K-Means Cluster Analysis. Distinction between the two groups was obtained only for binaural stimulation conditions, wherein all normal children were grouped under cluster 1 with higher slope values and 6 out of 9 CAPD children were grouped under cluster 2 with lower slopes. The results suggest that there may be several subcategories among children who are found to be at risk for CAPD. One of the subcategories may comprise children who exhibit poor ABR morphology, especially during binaural stimulation conditions, which could be due to binaural interference.

Outcome of brain stem auditory electrophysiology in children who survive purulent meningitis

Brain stem auditory electrophysiology was assessed in children long after purulent meningitis by examining the central components of brain stem auditory evoked response (BAER) at different presentation rates of clicks. Children with peripheral hearing loss were excluded from this study to avoid any possible influence of the loss on the measurements of BAER central components. Of the 70 children who had recovered from meningitis 2 to 8 years earlier, 9 (12.9%) showed abnormalities in BAER central components--mainly a slight reduction of wave V amplitude, at the click presentation rate of 10/s. Of the remaining 61 children who did not show any obvious abnormalities in the BAER at 10/s, an abnormally prolonged I-V interval and a reduced amplitude of wave V were seen in 5 children (8.2%) at the click rate of 90/s. The total BAER abnormality rate was therefore 20.0% (14/70 cases). The results suggest that most children who survive purulent meningitis have a favorable outcome for the brain stem auditory pathway, with about 1 in 5 having mild dysfunction or a suboptimal outcome in the pathway.

Immaturity of electrophysiological response of the neonatal auditory brainstem to high repetition rates of click stimulation

Changes in brainstem auditory evoked response (BAER) with varying stimulus repetition primarily represent neural processes concerning the efficacy of synaptic transmission in the brainstem auditory pathway. In this study the BAER to different rates of clicks was recorded from 16 term neonates. The results were compared with those from 16 adults to examine whether the degree of maturation of synaptic transmission of the neonatal brainstem auditory pathway parallels that of general function of the pathway. All BAER wave latencies and interpeak intervals increased linearly and wave amplitudes reduced with increasing click rate. The absolute rate-dependent changes in BAER measures were much greater in the neonates than in the adults, reflecting a significant immaturity in the efficacy of synaptic transmission in the neonatal auditory brainstem and in the ability of the neonatal brainstem to process rapid acoustic stimulation. When the data obtained at higher click rates at various age groups were analyzed as percentages, using the BAER measurements at conventionally used slow rate (21/s) of clicks as the denominators, the changing rates (%), or relative changes, of most BAER measures at higher rates in the neonates were still greater than those in the adults. Therefore, the rate-dependent BAER changes in the neonates are relatively less mature than general aspects of the BAER, reflected by the BAER elicited with conventionally used slow rates of clicks. These findings suggest that synaptic efficacy in the neonatal brainstem auditory pathway is relatively less mature than general function of the pathway and thus may be more susceptible to unfavourable perinatal conditions.

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.