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

Tone-burst elicited auditory brainstem responses in full-term and pre-term infants

OBJECTIVE

To investigate the reliability of tone-burst auditory brainstem response (TB-ABR) latencies and thresholds in pre-term and full-term infants.

DESIGN

TB-ABRs to 500 Hz and 4000 Hz tone-burst stimuli were recorded at two-week intervals over the first six weeks of life in a group of full-term infants (40-46 weeks gestational age [GA]) and over ten weeks (36-46 weeks gestation) in a group of preterm infants. Linear mixed model analyses evaluated within-subject changes and the effects of the subject group, age at assessment, and stimulus frequency on ABR latency and threshold.

STUDY SAMPLE

Twenty-four infants participated. Nine were full-term (GA: 39-41 weeks) and fifteen were healthy pre-term (GA: 28-34 weeks) at birth.

RESULTS

TB-ABR wave V latencies at 70 dBnHL decreased throughout the study (p < 0.001) in pre-term babies for both test frequencies by approximately 0.5 ms. There were, however, no group or GA (at birth) effects indicating that response latency normalized in these children by the due date. Similarly, TB-ABR threshold levels in the premature group were elevated (p = 0.001) by approximately 5 dB in pre-term evaluation but were equivalent to those of full-term participants in the post-term assessment period.

CONCLUSIONS

In healthy, pre-term infants, tone-burst ABR testing is reliable from 36 weeks gestation.

Auditory nerve phase-locked response recorded from normal hearing adults using electrocochleography

OBJECTIVE

The auditory nerve overlapped waveform response (ANOW), a new measure that can be recorded non-invasively from humans, holds promise for providing more accurate assessment of low frequency hearing thresholds than currently used objective measures. This research aims to investigate the robustness and the nature of the ANOW response in humans.

DESIGN

Repeated within-session recordings of the ANOW response using low-frequency Tone Bursts (TBs) were obtained at multiple stimulus levels. ANOW's absolute amplitude and phase locking value (PLV) measures were analysed to obtain normative data and to test the reliability of the ANOW response.

STUDY SAMPLE

Thirteen normal hearing adults within the age range of 25 to 40 years.

RESULTS

ANOW response was obtained to both 250 Hz and 500 Hz TBs and was traced down to 30-40 dB nHL. ANOW response showed significantly higher amplitude and stronger phase locking using 250 Hz TB compared to 500 Hz TB. High degree of test retest reliability of the ANOW response was found using 250 Hz TB at presentation levels higher than 40 dB nHL.

CONCLUSIONS

ANOW response is recordable noninvasively using low-frequency TBs and shows higher robustness as the stimulus frequency decreases.

Perceptual Encoding in Auditory Brainstem Responses: Effects of Stimulus Frequency

PURPOSE

A central question about auditory perception concerns how acoustic information is represented at different stages of processing. The auditory brainstem response (ABR) provides a potentially useful index of the earliest stages of this process. However, it is unclear how basic acoustic characteristics (e.g., differences in tones spanning a wide range of frequencies) are indexed by ABR components. This study addresses this by investigating how ABR amplitude and latency track stimulus frequency for tones ranging from 250 to 8000 Hz.

METHOD

In a repeated-measures experimental design, listeners were presented with brief tones (250, 500, 1000, 2000, 4000, and 8000 Hz) in random order while electroencephalography was recorded. ABR latencies and amplitudes for Wave V (6-9 ms) and in the time window following the Wave V peak (labeled as Wave VI; 9-12 ms) were measured.

RESULTS

Wave V latency decreased with increasing frequency, replicating previous work. In addition, Waves V and VI amplitudes tracked differences in tone frequency, with a nonlinear response from 250 to 8000 Hz and a clear log-linear response to tones from 500 to 8000 Hz.

CONCLUSIONS

Results demonstrate that the ABR provides a useful measure of early perceptual encoding for stimuli varying in frequency and that the tonotopic organization of the auditory system is preserved at this stage of processing for stimuli from 500 to 8000 Hz. Such a measure may serve as a useful clinical tool for evaluating a listener's ability to encode specific frequencies in sounds.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6987422.

Evaluation of optimal masking levels in place-specific low-frequency chirp-evoked auditory brainstem responses

The aim of the study is the experimental determination of the optimal required masking level for a given stimulus level when using a band limited "low-frequency chirp" in order to improve frequency and place specificity of auditory brainstem responses (ABRs). A low-frequency chirp (100-850 Hz) at stimulation levels between 40 and 80 dB normalized hearing level was presented to 12 normal hearing subjects. During presentation of each stimulus, the level of a high-pass noise with a low cutoff frequency of 1100 Hz was varied between 0 and 25 dB signal-to-noise ratio (SNR) by using 5 dB steps (at 0 dB SNR the same level of both the chirp and the masker in dB sound pressure level was presented). Measurements without masking were used as a reference. In all masking conditions, the latency of wave V was significantly increased compared to unmasked ABRs. The amplitude of wave V decreased when reaching the effective and therefore optimal masking level. Accordingly, in order to ensure place specificity of the ABR, ipsilateral masking is essential. At lower stimulus levels the SNR can be substantially increased (i.e., the masker level decreased) without loss of place specificity.

Evaluation of noise-induced hearing loss by auditory steady-state and auditory brainstem-evoked responses

OBJECTIVES

Noise-induced hearing loss (NIHL) may result from occupational noise exposures and is considered as an 'Occupational Disease'; therefore, it is compensable. To verify the existence and severity of the work-related hearing loss, there is a need of an objective, reliable auditory measure in cases of arbitration of financial disputes to resolve any medicolegal aspects. The objective of the study was to compare between the ABR and ASSR for predicting the behavioural threshold in subjects with normal hearing or NIHL.

DESIGN

The study included 82 subjects regularly exposed to high levels of occupational noise, with normal hearing and NIHL. ABR to clicks and to tone bursts were recorded followed by multiple-frequency ASSR. Physiological and behavioural thresholds were compared for specific frequencies (1000, 2000 Hz) and average of high-frequency range (2000 and 4000 Hz). In addition, Pearson correlations and the specificity and sensitivity of each measure were also calculated using receiver operating characteristic (ROC) curves.

RESULTS

In the NIHL group, there was a significantly smaller difference between the behavioural threshold and click-ABR than the ASSR in high-frequency range. Pearson correlations were significantly higher for click-ABR. Analysis of specific frequencies yielded a smaller difference between behavioural and ASSR than tone-burst-ABR thresholds, with a slightly better correlation for ASSR than tone-burst-ABR. Higher sensitivity but lower specificity was suggested for ASSR than ABR.

CONCLUSIONS

ASSR is associated with high-frequency specificity, shorter test sessions and good correlations with behavioural thresholds, making it a potentially better measure than ABR for predicting audiograms in subjects with NIHL. These findings have diagnostic implications, especially in cases of workers' compensation when subjects may be uncooperative.

Autism and peripheral hearing loss: a systematic review

OBJECTIVE

To systematically review the literature describing the relationship between autism spectrum disorder (ASD) and peripheral hearing loss including literature recommendations for audiological assessment and auditory habilitation in cases where peripheral hearing loss and ASD coexist.

DATA SOURCES

Published studies indexed in MEDLINE (1948-2011).

REVIEW METHODS

The search strategy identified 595 potential studies. After a review of the titles, 115 abstracts were reviewed and 39 articles were retrieved and assessed independently by at least two authors for possible inclusion. 22 articles pertained to children with ASD and peripheral hearing loss, hearing assessment in children with ASD, audiological habilitation for children with ASD or hyper-responsiveness in children with ASD. 17 further studies were garnered from the reference section of the 22 papers.

RESULTS

Controversy exists in the literature regarding prevalence of hearing impairment among individuals with ASD. In cases where ASD and hearing impairment co-exist, diagnosis of one condition often leads to a delay in diagnosing the other. Audiological assessment can be difficult in children with ASD and test-retest reliability of behavioural thresholds can be poor. In cases where hearing impairment exists and hearing aids or cochlear implantation are recommended, devices are often fit with special considerations for the child with ASD. Hyper-responsiveness to auditory stimuli may be displayed by individuals with ASD. Evidence or the suspicion of hyper-responsiveness may be taken into consideration when fitting amplification and planning behavioural intervention.

CONCLUSIONS

Prevalence rates of hearing impairment among individuals with ASD continue to be debated. At present there is no conclusive evidence that children with ASD are at increased risk of peripheral hearing loss. A complete audiological assessment is recommended in all cases where ASD is suspected so as not to delay the diagnosis of hearing impairment in the event that hearing loss and ASD co-exist. Objective assessment measures should be used to confirm behavioural testing in order to ensure reliability of audiological test results. Fitting of hearing aids or cochlear implantation are not contraindicated when hearing loss is present in children with ASD; however, success with these devices can be variable.

Tone burst stimulus for auditory brainstem responses: prediction of hearing threshold at 1kHz

OBJECTIVE

To assess differences in hearing threshold estimation of four different ABR tone-bursts at 1kHz.

METHODS

Twenty-one (21) ears from 11 subjects were tested with pure-tone audiometry (PTA): 5 ears (24%) were normal hearing, 5 (24%) affected by mild hearing loss, 7 (33%) showed moderate hearing loss and 4 (19%) severe hearing loss. After PTA each subject underwent tone-burst ABR test at 1kHz using a linear gated (L_ABR) or Blackman windowed (B_ABR) stimuli with (nn_ABR) and without ipsilateral notched noise. Stimulation rate and filters settings were unchanged.

RESULTS

Overall correlation between PTA and all ABRs thresholds was high, ranging from 0.84 to 0.94. In normal hearing ears none of the differences was significant, except for those measured with B_nn_ABR, which showed a mean 16dB overestimation of the pure-tone threshold (p<0.05). In mild hearing loss group none of the differences between thresholds were significant. In moderate and severe hearing loss groups significant differences were measured with L_nn_ABR (p<0.05) with a mean 7.5dB underestimation of PTA.

CONCLUSIONS

Although very similar, some significant differences were found when considering specific group of patients with different degrees of hearing loss.

Multiple auditory steady state response thresholds to bone conduction stimuli in adults with normal and elevated thresholds

OBJECTIVE

Auditory steady state responses (ASSRs) to multiple air conduction (AC) stimuli modulated at ∼80 Hz have been shown to provide reasonable estimates of the behavioral audiogram. To distinguish the type of hearing loss (i.e., conductive, sensorineural, or mixed), bone conduction (BC) results are necessary. There are few BC-ASSR data, especially for individuals with hearing loss. The present studies aimed to (1) determine multiple ASSR thresholds to BC stimuli in adults with normal hearing, masker-simulated hearing loss, and sensorineural hearing loss (SNHL) and (2) determine how well BC-ASSR distinguishes normal versus elevated thresholds to BC stimuli in adults with normal hearing or SNHL.

DESIGN

Multiple ASSR and behavioral thresholds for BC stimuli were determined in two studies. Study A assessed 16 normal-hearing adults with relatively flat threshold elevations produced by 50, 60, and 70 dB SPL AC masking noise, as well as no masking. Study B assessed 10 adults with normal hearing and 40 adults with SNHL. In both studies, the multiple (500 to 4000 Hz) ASSR stimuli were modulated between 77 and 101 Hz and varied in intensity from 0 to 50 dB HL in 10-dB steps. Stimuli were presented using a B71 bone oscillator held on the temporal bone by an elastic band while participants relaxed or slept.

RESULTS

Study A: Correlations (r) between behavioral and ASSR thresholds for all conditions combined were 0.77, 0.87, 0.90, and 0.87 for 500, 1000, 2000, and 4000 Hz, respectively. ASSR minus behavioral threshold difference scores for all frequencies combined for the no-masker, 50, 60, and 70 dB SPL masker conditions were 14.3 ± 9.2, 12.1 ± 10.4, 12.7 ± 7.7, and 11.4 ± 8.1 dB, respectively. Study B: The difference scores for 500, 1000, 2000, and 4000 Hz were, on average, 15.7 ± 12.3, 10.3 ± 10.7, 9.7 ± 10.3, and 5.7 ± 7.9 dB, respectively, with correlations of 0.73, 0.84, 0.87, and 0.94 for the normal-hearing and SNHL groups combined. The ASSR minus behavioral difference scores were significantly larger for 500 Hz and significantly smaller for 4000 Hz compared with 1000 and 2000 Hz. Across all frequencies, the BC-ASSR correctly classified 89% of thresholds as "normal" or "elevated" (92% correct for 1000, 2000, and 4000 Hz).

CONCLUSIONS

The threshold difference scores and correlations in individuals with SNHL are similar to those in normal listeners with simulated SNHL. These difference scores are also similar to those shown by previous studies for the AC-ASSR in individuals with SNHL, at least for 1000 to 4000 Hz. The BC-ASSR provides a reasonably good estimate of BC behavioral threshold in adults, especially between 1000 and 4000 Hz. Further research is required in infants with hearing loss.

Relationship between pure tone audiometry and tone burst auditory brainstem response at low frequencies gated with Blackman window

To assess the reliability of Blackman windowed tone burst auditory brainstem response (ABR) as a predictor of hearing threshold at low frequencies. Fifty-six subjects were divided in to three groups (normal hearing, conductive hearing loss, sensorineural hearing loss) after pure tone audiometry (PTA) testing. Then they underwent tone burst ABR using Blackman windowed stimuli at 0.5 kHz and 1 kHz. Results were compared with PTA threshold. Mean threshold differences between PTA and ABR ranged between 11 dB at 0.5 kHz and 14 dB at 1 kHz. ABR threshold was worse than PTA in each but 2 cases. Mean discrepancy between the two thresholds was about 20 dB in normal hearing, reducing in presence of hearing loss, without any differences in conductive and sensorineural cases. Tone burst ABR is a good predictor of hearing threshold at low frequencies, in case of suspected hearing loss. Further studies are recommended to evaluate an ipsilateral masking such as notched noise to ensure greater frequency specificity.

Maturation of auditory function related to hearing threshold estimations using the auditory brainstem response during infancy

OBJECTIVE

The objective of this study was to quantify the maturation of the Auditory Brainstem Response (ABR) at discrete periods during infancy and to provide a means to appropriately estimate hearing thresholds when the ABR is immature.

METHODS

A longitudinal study was designed to measure the in situ ABR thresholds of infants using air-conduction tone bursts of 500, 2000 and 4000Hz. Thresholds were measured using an eardrum-level microphone to eliminate the bias related to coupler-referenced scales such as the dB nHL scale used for adult assessments.

RESULTS

The study found that the in situ thresholds of a sample of normally developing infants decreased significantly during the first 6 months of life. A comparison of these in situ thresholds with those of normal-hearing adults revealed that the ABR response reached maturity in these infants between 4 and 6 months of age for the frequencies 500 and 2000Hz but remained immature, or elevated, at 6 months of age for 4000Hz.

CONCLUSIONS

The maturation of the ABR should be considered during the estimation of an infant's audiogram and subsequent diagnosis.

Electrophysiological and morphological development of the inner ear in Belgian Waterslager canaries

Belgian Waterslager (BW) canaries have an inherited hearing loss due to missing and abnormal hair cells, but it is unclear whether the loss is congenital or developmental. We used auditory brainstem responses and scanning electron microscopy to describe the development of auditory sensitivity and hair cell abnormalities in BW and non-BW canaries. In both strains, adult ABR thresholds were higher than behavioral thresholds, but BW canaries exhibited higher thresholds than non-BW canaries across all frequencies. Immediately post-hatch, ABR thresholds and hair cell numbers were similar in both strains. Two weeks later, thresholds were significantly higher in BW canaries, and hair cell number progressively decreased as the birds aged. These data show that in BW canaries: the peripheral auditory system is functionally similar to non-BW canary from hatch to 2 weeks, ABR thresholds improve during this developmental period, actually becoming better than those of adults, but then worsen as the bird continues to age. Hair cell number and appearance is similar to non-BW canaries at hatch but progressively declines after 30 days of age. These data show that the hearing loss characteristic of BW canaries is, at least in part, developmental and is established by the time song learning begins.

Frequency-specific objective audiometry: Tone-evoked brainstem responses and steady-state responses to 40 Hz and 90 Hz amplitude modulated stimuli

Tone-evoked Auditory Brainstem Responses (tone-burst ABRs) and Auditory Steady-State Responses (ASSRs) with 40 or 90 Hz amplitude modulation (AM) were compared, using the same equipment and recording parameters, to determine which of these three methods most accurately approached the behavioural hearing thresholds in response to 500 Hz and 2000 Hz stimuli in eleven awake adults with normal hearing. Estimates of the thresholds obtained with the three methods were 10, 18, and 26 dB SL at 500 Hz; and 10, 12, and 22 dB SL at 2000 Hz; using 40 Hz ASSR, 90 Hz ASSR, and tone-burst ABR, respectively. ASSRs with 40 Hz AM stimuli produced significantly better results (lowest thresholds with SD=0), whereas the wave-V analysis on the tone-burst ABR produced the poorest results. In the averaged ABRs, a robust steady-state potential was also visible. Analysis of those steady-state responses showed estimated thresholds of 13 and 14 dB SL (at 500 and 2000 Hz, respectively), thus considerably better than the estimated thresholds from the wave-V analysis. It is concluded that the 40 Hz ASSR showed superior results, especially at 500 Hz.

Auditory brainstem and middle latency responses to 1 kHz tones in noise-masked normally-hearing and sensorineurally hearing-impaired adults

The present study provides comparative evaluation of the ABR and MLR to 1 kHz brief tones in two groups of hearing-impaired subjects (noise-masked normally-hearing; and sensorineurally hearing-impaired adults), as well as a normally-hearing control group. Tones were presented at intensities from threshold to 80-90 dB nHL. The results of this study show that: (1) the ABR and MLR to these low-frequency (1 kHz) tones are equally accurate in estimating hearing threshold, (2) at supra-threshold levels, there are differences in the ABRs and MLRs for subjects with decreased hearing sensitivity resulting from cochlear pathology, compared to those obtained from adults with simulated hearing loss due to broadband masking, and (3) supra-threshold stimuli produce differential effects on the latency and amplitude characteristics of the ABR and MLR in listeners with true sensorineural hearing impairments. Possible physiologic explanations are offered for this differential pattern of results.

Realignment of interaural cortical maps in asymmetric hearing loss

Misalignment of interaural cortical response maps in asymmetric hearing loss evolves from initial gross divergence to near convergence over a 6 month recovery period. The evolution of left primary auditory cortex (AI) interaural frequency map changes is chronicled in squirrel monkeys with asymmetric hearing loss induced by overstimulating the right ear with a 1 kHz tone at 136 dB for 3 h. AI frequency response areas (FRAs), derived from tone bursts presented to the poorer or better hearing ears, are compared at 6, 12, and 24 weeks after acoustic overstimulation. Characteristic frequency (CF) and minimum threshold parameters are extracted from FRAs, and they are used to quantify interaural response map differences. A large interaural CF map misalignment of DeltaCF approximately 1.27 octaves at 6 weeks after overstimulation decreases substantially to DeltaCF approximately 0.62 octave at 24 weeks. Interaural cortical threshold map misalignment faithfully reflects peripheral asymmetric hearing loss at 6 and 12 weeks. However, AI threshold map misalignment essentially disappears at 24 weeks, primarily because ipsilateral cortical thresholds have become unexpectedly elevated relative to peripheral thresholds. The findings document that plastic change in central processing of sound stimuli arriving from the nominally better hearing ear may account for progressive realignment of both interaural frequency and threshold maps.

Effects of age and degree of hearing loss on the agreement and correlation between sound field audiometric thresholds and tone burst auditory brainstem response thresholds in infants and young children

BACKGROUND/PURPOSE

Early hearing rehabilitation programs eventually require measurement of the hearing threshold cutoff values over the whole range of speech frequencies. With tone burst auditory brainstem responses, excellent agreement and correlation between evoked-potential and behavioral thresholds have been demonstrated by previous studies. This study investigated the effects of different ages and degrees of hearing loss on the agreement and correlation in a large series of infants and young children in Taiwan.

METHODS

Medical records were reviewed from a large series of 1281 infants and young children aged from 3 months to 3 years who had undergone diagnostic audiometry, including sound field audiometry and tone burst auditory brainstem response measurements. The effects of age and hearing loss on the agreement and correlation between two measured thresholds were studied.

RESULTS

Significant correlations (p < 0.001) were seen between the two measured thresholds across groups of different ages and different degrees of hearing loss greater than 20 dB HL. However, the degree of correlation deteriorated at lower degrees of hearing loss. Correlations for hearing thresholds less than 20 dB HL were not significant at 1000, 2000 and 4000 Hz.

CONCLUSION

The evoked-potentials test, properly obtained and interpreted with respect to the effects of age and degree of hearing loss, may provide a very informative hearing threshold reference to help in behavioral audiometric evaluation in infants and young children with hearing loss.

Effects of aging on brainstem responses to toneburst auditory stimuli: a cross-sectional and longitudinal study in dogs

BACKGROUND

It is assumed that the hearing of dogs becomes impaired with advancing age, but little is known about the prevalence and electrophysiologic characteristics of presbycusis in this species.

HYPOTHESIS

As in humans, hearing in dogs becomes impaired with aging across the entire frequency range, but primarily in the high-frequency area. This change can be assessed quantitatively by brainstem-evoked response audiometry (BERA).

ANIMALS

Three groups of 10 mixed-breed dogs with similar body weights but different mean ages were used. At the start of the study, the mean age was 1.9 years (range, 0.9-3.4) in group I, 5.7 years (3.5-7) in group II, and 12.7 years (11-14) in group III.

METHODS

In a cross-sectional study, the BERA audiograms obtained with toneburst stimuli were compared among the 3 groups. In a longitudinal study, changes in auditory thresholds of group II dogs were followed for 7 years.

RESULTS

Thresholds were significantly higher in group III than in groups I and II at all frequencies tested, and higher in group II than in group I at 4 kHz. The audiograms in group II indicated a progressive increase in thresholds associated with aging starting around 8-10 years of age and most pronounced in the middle- to high-frequency region (8-32 kHz).

CONCLUSIONS AND CLINICAL IMPORTANCE

Age-related hearing loss in these dogs started around 8-10 years of age and encompassed the entire frequency range, but started and progressed most rapidly in the middle- to high-frequency area. Its progression can be followed by BERA with frequency-specific stimulation.

Envelope and spectral frequency-following responses to vowel sounds

Frequency-following responses (FFRs) were recorded to two naturally produced vowels (/a/ and /i/) in normal hearing subjects. A digitally implemented Fourier analyzer was used to measure response amplitude at the fundamental frequency and at 23 higher harmonics. Response components related to the stimulus envelope ("envelope FFR") were distinguished from components related to the stimulus spectrum ("spectral FFR") by adding or subtracting responses to opposite polarity stimuli. Significant envelope FFRs were detected at the fundamental frequency of both vowels, for all of the subjects. Significant spectral FFRs were detected at harmonics close to formant peaks, and at harmonics corresponding to cochlear intermodulation distortion products, but these were not significant in all subjects, and were not detected above 1500 Hz. These findings indicate that speech-evoked FFRs follow both the glottal pitch envelope as well as spectral stimulus components.

Tone-evoked brainstem responses and auditory steady state responses to 40hz and 80hz amplitude modulated stimuli with different frequencies - a comparative study

Tone burst evoked auditory brainstem responses and auditory steady state responses with 40 or > 80 Hz modulation can be used to determine frequency specific threshold.

AIM

The present study was taken up to check for the efficacy of estimating hearing thresholds by tone burst ABR and ASSR. The frequency effect (low, mid and high) on estimating the threshold was also focused upon.

METHODS

20 normal hearing adults (40 ears) in the age range of 16 to 30 years participated in the study. The pure tone audiometry and immittance was initially done. Subsequently, tone-burst ABR, 80Hz ASSR and 40Hz ASSR to estimate the threshold with three frequencies 500Hz (low), 2000Hz (mid) and 4000Hz (high) was done. The data was analyzed statistically using pair sample t-test.

RESULTS

ASSR threshold for 80Hz and 40Hz was almost comparable. ASSR was superior to estimate the threshold than tone-burst ABR. For the low frequency the discrepancy between the behavioral threshold and frequency-specific evoked audiometry was more when compared to mid and high frequency.

CONCLUSION

Present study showed that steady-state responses were efficient means of threshold detection than visual detection of ABR wave-V. In awake adult subjects, 40Hz and 80Hz amplitude modulated produced similar results. For the threshold estimation ASSR was better than tone-burst ABR.

Comparison of auditory steady-state responses and auditory brainstem responses in audiometric assessment of adults with sensorineural hearing loss

OBJECTIVE

Many of the medico-legal patients who claimed compensation may exaggerate hearing loss that varies in degree, nature, and laterality. The purpose of this study was to investigate whether Auditory Steady-State Response (ASSR) could be used to predict the hearing level of adults, and whether ASSR could become a better testing method than Auditory brainstem response (ABR) in audiometric assessment of adults with sensorineural hearing loss.

METHODS

This was a prospective study, which was conducted in a tertiary referral hospital. From January to June 2007, 142 subjects (284 ears) with varying degrees of sensori-neural hearing impairment were included in this study. Four commonly used frequencies (500, 1000, 2000, 4000Hz) were evaluated. All subjects received pure-tone audiometry, multi-channel ASSR, and ABR tests for threshold measurement. The correlation of pure tone thresholds with ASSR and ABR thresholds were assessed.

RESULTS

Between multi-channel ASSR and pure tone thresholds, a difference of less than 15dB was found in 71% while a difference of less than 25dB was found in 89% of patients. The correlation coefficient (r) of multi-channel ASSR and pure tone thresholds were 0.89, 0.95, 0.96, and 0.97 at 500, 1000, 2000, and 4000Hz, respectively. The strength of the relationship increased with increasing frequency. On the other hand, between ABR and pure-tone thresholds, a difference of less than 15dB was found in 31%; a difference of less than 25dB was found in 62% of patients. The r correlation value for ABR and pure tone thresholds was 0.83.

CONCLUSION

ASSR is a more reliable test for the accurate prediction of auditory thresholds than ABR. It can be a powerful and convenient electro-physiologic examination tool for clinically assessing of adults with sensorineural hearing loss.

Validation of multi-channel auditory steady-state response in adults with sensorineural hearing loss

OBJECTIVE

For various medico-legal and financial reasons, some patients may clinically demonstrate an exaggerated hearing loss that varies in degree, nature and laterality. The purpose of this study was to evaluate whether multi-channel auditory steady-state response measurement can be used as an objective test of auditory thresholds in adults with sensorineural hearing loss.

STUDY DESIGN AND SETTING

This was a prospective, comparative, experimental research design study conducted in an academic medical centre. From January to June 2007, 142 subjects (284 ears) with varying degrees of sensorineural hearing loss were included. Four commonly used frequencies (500, 1000, 2000 and 4000 Hz) were evaluated. Both pure tone thresholds and multi-channel auditory steady-state response thresholds were obtained for each ear in all subjects. The correlation of auditory steady-state response thresholds and pure tone thresholds was assessed. The time taken for multi-channel auditory steady-state response testing was also recorded.

RESULTS

Results for multi-channel auditory steady-state response thresholds and pure tone thresholds were compared for each test frequency. A difference of less than 15 dB was found in 71 per cent of patients, while a difference of less than 20 dB was found in 83 per cent. Correlation between auditory steady-state response thresholds and pure tone thresholds, expressed as the correlation coefficient (r), was 0.89, 0.95, 0.96 and 0.97 at 500, 1000, 2000 and 4000 Hz, respectively. The strength of the relationship between auditory steady-state response thresholds and pure tone thresholds increased with increasing frequency and increasing degree of hearing loss. The recorded auditory steady-state response thresholds were used to calculate regression lines predicting pure tone threshold results. The mean estimated pure tone thresholds calculated from these regression lines were all within 10 dB of the actual recorded pure tone thresholds. The average multi-channel auditory steady-state response test duration was 42 minutes per patient.

CONCLUSION

Measurement of multi-channel auditory steady-state response could be a powerful, convenient electro-physiological examination with which to objectively certify clinical hearing impairment in adults.

Tone-evoked ABR in full-term and preterm neonates with normal hearing

This study was designed to investigate the feasibility of applying tone-ABRs in the nursery and neonatal intensive care unit (NICU), and to provide normative tone-ABR data from neonates. Normative tone-ABR latency data were determined. The study obtained intensity series of tone-ABRs from thirty preterm neonates and twenty full-term neonates who had confirmed normal peripheral auditory function after passing both an OAE and ABR screening examination. ABRs were collected in response to 500, 1500, and 4000 Hz tone bursts at 70, 50, 30, and 20 dB nHL. Mean wave V latencies were compared between groups, ears, and by gender. Responses to tone bursts of 20 and 30 dB nHL were detected in 97% and 100% of all ears respectively, in addition to responses to the higher-intensity stimuli. Preterm neonates' ABRs showed significantly longer latencies than those of the full-term infants. Tone-ABR evaluation was found to be both feasible and reliable as a measure of auditory function in neonates.

Thresholds of tone burst auditory brainstem responses for infants and young children with normal hearing in Taiwan

BACKGROUND/PURPOSE

With respect to follow-up from newborn hearing screening, click evoked auditory brainstem response provides relatively accurate estimates of auditory thresholds at a broad frequency range between 1,000 Hz and 4,000 Hz. Further on the frequency-specific hearing evaluation, recent studies conclude that tone burst auditory brainstem response estimates the behavioral thresholds reasonably well. This study reports the preliminary data of tone burst auditory brainstem response measurements of infants and young children with normal hearing in Taiwan.

METHODS

Ninety-four infants and young children aged from 3 months to 3 years of age were recruited as they were eventually determined to have normal hearing after a series of tests. They underwent tone burst auditory brainstem response measurements at four selected frequencies. Statistical methods were applied to study the relationship among recorded variables.

RESULTS

The results indicated that the averaged tone burst auditory brainstem response thresholds of infants and young children with normal hearing in Taiwan are typically 10-20 dB nHL at 500, 1,000, 2,000, and 4,000 Hz, which is similar to the reported tone burst auditory brainstem response thresholds in adults with normal hearing. There was no statistically significant difference for the thresholds with regard to gender, laterality, and age distribution in this study.

CONCLUSION

Based on the published research and our study, we suggest setting the normal criterion levels for infants and young children in Taiwan of the tone burst auditory brainstem response to air-conducted tones as 30 dB nHL for 500 and 1,000 Hz, and 25 dB nHL for 2,000 and 4,000 Hz.

Effects of auditory pathway anatomy and deafness characteristics? Part 2: On electrically evoked late auditory responses

The purpose of this study was to distinguish the effects of different parameters on latencies of wave N1, wave P2, and inter-peak interval N1-P2 of electrical late auditory responses (ELARs). ELARs were recorded from four intra-cochlear electrodes in fourteen adult HiRes90K cochlear implant users who had at least three months of experience. The relationship between latencies and stimulation sites in the cochlea was characterized to assess the influence of the auditory pathway anatomy on ELARs, i.e., whether the speed of neural propagation varies according to the place that is activated in the cochlea. Audiograms before implantation, duration of deafness, and psychophysics at first fitting were used to describe the influence of deafness characteristics on latencies. The stimulation sites were found to have no effect on ELAR latency and, while there was no influence of psychophysics on latency, a strong relationship was shown with duration of deafness and the pre-implantation audiogram. Thus, ELAR latency was longer for poorer audiograms and longer durations of deafness and this relationship appeared to be independent of stimulation parameters such as stimulation site. Comparison between these findings and those from the equivalent study on EABR waves IIIe and Ve latency [Guiraud, J., Gallego, S., Arnold, L., Boyle, P., Truy, E., Collet, L., 2007. Effects of auditory pathway anatomy and deafness characteristics? (1): On electrically evoked auditory brainstem responses. Hear. Res. 223 (1-2), 48-60] shows that, while ELAR and EABR latencies are related with parameters that reflect the integrity of the auditory pathway, ELAR latency is less dependent on stimulation parameters than EABR latency.

Comparison of Auditory Steady-State Responses and Tone-Burst Auditory Brainstem Responses in Normal Babies

OBJECTIVE

To follow the development of tone-burst auditory brainstem response (TB-ABR) and auditory steady-state response (ASSR) thresholds in a group of normal babies through the first 6 wk of life.

DESIGN

This longitudinal study involved assessment at four data-collection points. TB-ABR and ASSR thresholds to 500-Hz and 4-kHz stimuli were established in 17 full-term subjects at 0, 2, 4, and 6 wk of age. Stimulus-modulation rates for ASSR assessment were 74 Hz (for 500-Hz tones) and 95 Hz (for 4-kHz tones). TB-ABR responses were recorded to stimuli presented at 39.1 Hz.

RESULTS

Mean ASSR thresholds (calibrated in dBHL) at 500 Hz ranged from 44.4 to 39.7 dB HL across the recording period, and at 4 kHz they ranged from 37.9 to 32.1 dB HL. TB-ABR thresholds (calibrated in dBnHL) were significantly lower, ranging from 36.8 to 36.2 dB nHL at 500 Hz and from 16.5 to 15.9 dB nHL at 4 kHz. However, when the stimuli used for each test were calibrated in the same units (peak equivalent dB SPL), the results were similar. That is, the differences between the two techniques were only an artifact of the calibration. ASSR thresholds were more variable than TB-ABR, particularly at the neonatal measurement point. Within-subject changes across the test period were observed for ASSR thresholds but not for TB-ABR.

CONCLUSIONS

The longitudinal findings presented in this study suggest that for normal neonates, the TB-ABR technique may offer a more reliable basis for prediction of hearing levels than ASSR assessment. This is not because TB-ABR thresholds (calibrated in dBnHL) are lower, but because the response is less affected by maturational development in the first weeks of life and is less variable across subjects.

Auditory steady-state evoked potentials (ASSEPs): a study of optimal stimulation parameters for frequency-specific threshold measurement in dogs

OBJECTIVE

To define the optimal stimulation parameters (AM/FM vs AM alone and modulation rate) for frequency-specific threshold measurements using ASSEPs in dogs. Dependent variables were thresholds and recording times needed to obtain a response at threshold. To compare the ASSEP threshold results obtained with the optimal stimulation parameters to those obtained with the Tone-Burst/Auditory Brainstem Response (TB/ABR) combination.

METHODS

Thirty-two sedated Beagle puppies were tested at 5 audiometric frequencies (0.5-8 kHz) and 6 ASSEP modulation rates (21-199 Hz).

RESULTS

The ASSEP threshold-modulation rate functions had a high-pass profile with corner frequencies of 101 Hz for 0.5, 1 and 2 kHz carriers and of 151 Hz for 4 and 8 kHz carriers. AM stimuli did not yield higher thresholds than the AM/FM ones except at 1 kHz. Modulation type had no effect on testing duration. Audiometric profiles were obtained much more rapidly with ASSEPs than with TB/ABRs (mean: 50 vs 135 min). Both ASSEP and TB/ABR provided thresholds estimates characterized by low intersubject variability.

CONCLUSIONS

ASSEPs are a valid and rapid method for audiometric assessment in sedated dogs.

SIGNIFICANCE

ASSEPs offer a new, competitive tool for frequency-specific assessment of hearing in the canine species.

Using a combination of click- and tone burst-evoked auditory brain stem response measurements to estimate pure-tone thresholds

DESIGN

A retrospective medical record review of evoked potential and audiometric data were used to determine the accuracy with which click-evoked and tone burst-evoked auditory brain stem response (ABR) thresholds predict pure-tone audiometric thresholds.

METHODS

The medical records were reviewed of a consecutive group of patients who were referred for ABR testing for audiometric purposes over the past 4 yrs. ABR thresholds were measured for clicks and for several tone bursts, including a single-cycle, Blackman-windowed, 250-Hz tone burst, which has a broad spectrum with little energy above 600 Hz. Typically, the ABR data were collected because the patients were unable to provide reliable estimates of hearing sensitivity, based on behavioral test techniques, due to developmental level. Data were included only if subsequently obtained behavioral audiometric data were available to which the ABR data could be compared. Almost invariably, the behavioral data were collected after the ABR results were obtained. Because of this, data were included on only those ears for which middle ear tests (tympanometry, otoscopic examination, pure-tone air- and bone-conduction thresholds) indicated that middle ear status was similar at the times of both tests. With these inclusion criteria, data were available on 140 ears of 77 subjects.

RESULTS

Correlation was 0.94 between click-evoked ABR thresholds and the average pure-tone threshold at 2 and 4 kHz. Correlations exceeded 0.92 between ABR thresholds for the 250-Hz tone burst and low-frequency behavioral thresholds (250 Hz, 500 Hz, and the average pure-tone thresholds at 250 and 500 Hz). Similar or higher correlations were observed when ABR thresholds at other frequencies were compared with the pure-tone thresholds at corresponding frequencies. Differences between ABR and behavioral threshold depended on behavioral threshold, with ABR thresholds overestimating behavioral threshold in cases of normal hearing and underestimating behavioral threshold in cases of hearing loss.

CONCLUSIONS

These results suggest that ABR thresholds can be used to predict pure-tone behavioral thresholds for a wide range of frequencies. Although controversial, the data reviewed in this paper suggest that click-evoked ABR thresholds result in reasonable predictions of the average behavioral thresholds at 2 and 4 kHz. However, there were cases for which click-evoked ABR thresholds underestimated hearing loss at these frequencies. There are several other reasons why click-evoked ABR measurements were made, including that they (1) generally result in well-formed responses, (2) assist in determining whether auditory neuropathy exists, and (3) can be obtained in a relatively brief amount of time. Low-frequency thresholds were predicted well by ABR thresholds to a single-cycle, 250-Hz tone burst. In combination, click-evoked and low-frequency tone burst-evoked ABR threshold measurements might be used to quickly provide important clinical information for both ends of the audiogram. These measurements could be supplemented by ABR threshold measurements at other frequencies, if time permits. However, it may be possible to plan initial intervention strategies based on data for these two stimuli.

Clinical protocols for hearing instrument fitting in the Desired Sensation Level method

A discussion of the protocols used particularly in the clinical application of the Desired Sensation Level (DSL) Method is presented in this chapter. In the first section, the measurement and application of acoustic transforms is described in terms of their importance in the assessment phase of the amplification fitting process. Specifically, the implications of individual ear canal acoustics and their impact on accurately defining hearing thresholds are discussed. Detailed information about the statistical strength of the real-ear-to-coupler difference (RECD) measurement and how to obtain the measure in young infants is also provided. In addition, the findings of a study that examined the relationship between behavioral and electrophysiologic thresholds in real-ear SPL is described. The second section presents information related to the electroacoustic verification of hearing instruments. The RECD is discussed in relation to its application in simulated measurements of real-ear hearing instrument performance. In particular, the effects of the transducer and coupling method during the RECD measurement are described in terms of their impact on verification measures. The topics of insertion gain, test signals, and venting are also considered. The third section presents three summary tables that outline the hearing instrument fitting process for infants, children, and adults. Overall, this chapter provides both clinical and scientific information about procedures used in the assessment and verification stages of the DSL Method.

The Desired Sensation Level multistage input/output algorithm

The Desired Sensation Level (DSL) Method was revised to support hearing instrument fitting for infants, young children, and adults who use modern hearing instrument technologies, including multichannel compression, expansion, and multimemory capability. The aims of this revision are to maintain aspects of the previous versions of the DSL Method that have been supported by research, while extending the method to account for adult-child differences in preference and listening requirements. The goals of this version (5.0) include avoiding loudness discomfort, selecting a frequency response that meets audibility requirements, choosing compression characteristics that appropriately match technology to the user's needs, and accommodating the overall prescription to meet individual needs for use in various listening environments. This review summarizes the status of research on the use of the DSL Method with pediatric and adult populations and presents a series of revisions that have been made during the generation of DSL v5.0. This article concludes with case examples that illustrate key differences between the DSL v4.1 and DSL v5.0 prescriptions.

Comparison of multiple auditory steady-state responses (80 versus 40 Hz) and slow cortical potentials for threshold estimation in hearing-impaired adults

This study evaluated the use of multiple auditory steady-state responses (ASSRs) and slow cortical potentials (SCPs) to estimate behavioural audiograms in adults for compensation cases. Two groups of 23 subjects were assessed using either 80 Hz or 40 Hz multiple simultaneous tones with carrier frequencies of 0.5, 1.0, 2.0, and 4.0 kHz. SCP thresholds for 0.5, 1.0, and 2.0 kHz were obtained for both groups. Mean evoked potential thresholds (dB HL) minus behavioural pure-tone thresholds (dB HL) difference scores were 5-17 dB for the 80 Hz group, 1-14 dB for the 40 Hz group, and 20-22 dB for the SCPs. Thresholds for 40 Hz ASSR were significantly closer to behavioural thresholds than were 80 Hz or SCP thresholds. SCP and 40 Hz ASSR audiogram estimates were obtained more quickly than the 80 Hz ASSR. Multiple 40 Hz ASSR is the method of choice for evoked potential threshold estimation in adults.

Threshold Prediction Using the Auditory Steady-State Response and the Tone Burst Auditory Brain Stem Response: A Within-Subject Comparison

OBJECTIVE

The purpose of this study was to evaluate the accuracy with which auditory steady-state response (ASSR) and tone burst auditory brain stem response (ABR) thresholds predict behavioral thresholds, using a within-subjects design. Because the spectra of the stimuli used to evoke the ABR and the ASSR differ, it was hypothesized that the predictive accuracy also would differ, particularly in subjects with steeply sloping hearing losses.

DESIGN

ASSR and ABR thresholds were recorded in a group of 14 adults with normal hearing, 10 adults with flat, sensorineural hearing losses, and 10 adults with steeply sloping, high-frequency, sensorineural hearing losses. Evoked-potential thresholds were recorded at 1, 1.5, and 2 kHz and were compared with behavioral, pure-tone thresholds. The predictive accuracy of two ABR protocols was evaluated: Blackman-gated tone bursts and linear-gated tone bursts presented in a background of notched noise. Two ASSR stimulation protocols also were evaluated: 100% amplitude-modulated (AM) sinusoids and 100% AM plus 25% frequency-modulated (FM) sinusoids.

RESULTS

The results suggested there was no difference in the accuracy with which either ABR protocol predicted behavioral threshold, nor was there any difference in the predictive accuracy of the two ASSR protocols. On average, ABR thresholds were recorded 3 dB closer to behavioral threshold than ASSR thresholds. However, in the subjects with the most steeply sloping hearing losses, ABR thresholds were recorded as much as 25 dB below behavioral threshold, whereas ASSR thresholds were never recorded more than 5 dB below behavioral threshold, which may reflect more spread of excitation for the ABR than for the ASSR. In contrast, the ASSR overestimated behavioral threshold in two subjects with normal hearing, where the ABR provided a more accurate prediction of behavioral threshold.

CONCLUSIONS

Both the ABR and the ASSR provided reasonably accurate predictions of behavioral threshold across the three subject groups. There was no evidence that the predictive accuracy of the ABR evoked using Blackman-gated tone bursts differed from the predictive accuracy observed when linear-gated tone bursts were presented in conjunction with notched noise. Similarly, there was no evidence that the predictive accuracy of the AM ASSR differed from the AM/FM ASSR. In general, ABR thresholds were recorded at levels closer to behavioral threshold than the ASSR. For certain individuals with steeply sloping hearing losses, the ASSR may be a more accurate predictor of behavioral thresholds; however, the ABR may be a more appropriate choice when predicting behavioral thresholds in a population where the incidence of normal hearing is expected to be high.

Tonfrequenzevozierte Potenziale

Auditory evoked responses to tone-pips in notched-noise provide frequency specific estimations of thresholds. Most often, test frequencies are 0.5-4 kHz. Thresholds are expected to match with a high degree to behavioral thresholds. However, only few studies are available containing data on stimulus and averaging parameters, especially at a test frequency of 0.25 kHz. In order to find "optimal" parameters for a widely used device (Nicolet Spirit Version 1.6), we designed five experiments on stimulus polarity (Exp.I), sweep frequency (Exp.II), stimulus duration (Exp.III), notched noise level (Exp.IV), and threshold estimation (Exp.V). The experiments also included a low test frequency of 0.25 kHz. These experiments were applied to 29 healthy volunteers (n=29, aged 20-41 years with normal hearing and no history of illness of the ear). We found that alternating stimulus polarity and a sweep frequency of 43.5/s evoked responses that were highest with respect to amplitudes (0.2-0.4 mV) and correlations (0.49-0.91). A novel finding of the study was that the highest amplitudes and correlations could be achieved if stimulus durations and notched-noise-levels were specifically adjusted to the test frequencies (stimulus durations 0.25 kHz: 4 ms, 0.5 Hz: 2 ms, 1-4 kHz: 1 ms, notched-noise-levels 0.25-0.5 Hz: +10 dB, 1-4 kHz: +/-0 dB). Deviations from behavioral thresholds did not exceed +/-5 dB in 93% of the measures. The results indicate that frequency specific auditory evoked responses provide reliable threshold estimations. Future experiments are required to confirm the threshold deviations for hard of hearing individuals.

Effect of Audiometric Configuration on Threshold and Suprathreshold Auditory Steady-State Responses

OBJECTIVE

The purpose of this study was to examine the correlation between auditory steady-state response (ASSR) thresholds and behavioral thresholds in hearing-impaired adults with two common audiometric configurations. A second goal was to compare suprathreshold ASSR growth functions in these two subject groups and to determine whether these growth functions could be used clinically to improve threshold estimation.

DESIGN

Thirty adults participated, including 10 subjects with normal hearing, 10 subjects with flat moderately severe sensorineural hearing loss, and 10 subjects with sloping high-frequency sensorineural hearing loss. The accuracy of ASSR threshold estimations for the frequencies of 500, 1000, 2000, and 4000 Hz was compared across groups. In addition, ASSRs were recorded at multiple suprathreshold intensity levels, and the growth of the response was compared across subject groups.

RESULTS

ASSR and behavioral thresholds were strongly correlated across all subjects, with no significant difference by audiometric configuration. Slightly poorer correlations were obtained in the normal-hearing subjects than in hearing-impaired subjects and for the 500-Hz test frequency compared with the higher stimulus frequencies. Subtraction and regression methods for predicting behavioral thresholds from ASSR thresholds were equally accurate. Suprathreshold amplitude growth was variable among individuals, but mean growth functions showed steeper slopes in hearing-impaired subjects than in normal-hearing subjects, particularly for the higher frequencies (2000 to 4000 Hz). However, there was not a significant difference in the slopes of amplitude growth functions between subjects with sloping versus flat audiometric configurations for these frequencies, and estimation of threshold from suprathreshold ASSR amplitude growth functions was not advantageous.

CONCLUSIONS

ASSR thresholds accurately predicted behavioral threshold equally well for flat or sloping audiometric configurations. The accuracy of threshold estimation for either audiometric configuration and the similar growth function slopes may suggest that there is little spread of activation to neighboring regions of the cochlea when using multiple 100% AM stimuli in subjects with moderately sloping losses. The small amplitude of the ASSR response and individual variability may make threshold estimation based on extrapolation from suprathreshold ASSR responses impractical.

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.

Estimation of Hearing Loss in Children

The current pediatric test battery is limited in the severe-to-profound hearing loss range by the inability to obtain frequency-specific thresholds. Auditory steady-state response (ASSR) is an evoked potential test that can accurately measure auditory sensitivity beyond the limits of other test methods. The limited amount of clinical research, however, has delayed the acceptance of ASSR into the standard pediatric test battery. This study compared thresholds from 76 children using ASSR, ABR, and behavioral test methods. Resulting correlations were strong and supported the inclusion of ASSR into the standard pediatric test battery. ASSR testing provides audiometric information that is essential in the management of children with severe-to-profound hearing loss.

Presbyacusis and the auditory brainstem response

Age-related hearing loss (ARHL or presbyacusis) is an increasingly common form of sensorineural hearing loss (SNHL) as a result of changing demographics, and the auditory brainstem response (ABR) is a common experimental and clinical tool in audiology and neurology. Some of the changes that occur in the aging auditory system may significantly influence the interpretation of the ABR in comparison to the ABRs of younger adults. The approach of this review will be to integrate physiological and histopathological data from human and animal studies to provide a better understanding of the array of age-related changes in the ABR and to determine how age-related changes in the auditory system may influence how the ABR should be interpreted in presbyacusis. Data will be described in terms of thresholds, latencies, and amplitudes, as well as more complex auditory functions such as masking and temporal processing. Included in the review of data will be an attempt to differentiate between age-related effects that may strictly be due to threshold elevation from those that may be due to the aging process.

Place specificity of multiple auditory steady-state responses

Auditory steady-state responses (ASSRs) were elicited by simultaneously presenting multiple AM (amplitude-modulated) tones with carrier frequencies of 500, 1000, 2000, and 4000 Hz and modulation frequencies of 77, 85, 93, and 102 Hz, respectively. Responses were also evoked by separately presenting single 500- or 2000-Hz AM tones. The objectives of this study were (i) to determine the cochlear place specificity of single and multiple ASSRs using high-pass noise masking and derived-band responses, and (ii) to determine if there were any differences between single- and multiple-stimulus conditions. For all carrier frequencies, derived-band ASSRs for 1-octave-wide derived bands ranging in center frequency from 0.25 to 8 kHz had maximum amplitudes within a 1/2 octave of the carrier frequency. For simultaneously presented AM tones of 500, 1000, 2000, and 4000 Hz, bandwidths for the function of derived-band ASSR amplitude by derived-band center frequency were 476, 737, 1177, and 3039 Hz, respectively. There were no significant differences when compared to bandwidths of 486 and 1371 for ASSRs to AM tones of 500 or 2000 Hz presented separately. Results indicate that ASSRs to moderately intense stimuli (60 dB SPL) reflect activation of reasonably narrow cochlear regions, regardless of presenting AM tones simultaneously or separately.

ABR thresholds to tonebursts gated with Blackman and linear windows in adults with high-frequency sensorineural hearing loss

OBJECTIVE

The goal of this study was to determine whether tonebursts gated on and off using a nonlinear, exact-Blackman-gating function would be a more frequency-specific stimulus for auditory brain stem response audiometry than the more traditional 2-1-2 cycle linearly gated toneburst.

DESIGN

Toneburst ABRs were recorded in 10 adults with normal hearing and in 18 adults with sloping high-frequency sensorineural hearing loss. It was hypothesized that any advantage of the Blackman stimuli for frequency-specific threshold assessment should be evident in hearing-impaired subjects with hearing loss confined to the 2000 to 4000 Hz frequency region since spectral splatter in the toneburst stimuli could lead to an underestimation of hearing loss based on the ABR thresholds. ABR stimuli consisted of 2000- and 4000-Hz 2-1-2 (rise-plateau-fall) cycle linearly gated tonebursts and 1-0-1 msec exact-Blackman-gated tonebursts. An additional 0.5-0-0.5 msec 4000-Hz Blackman-gated toneburst was used to investigate whether the difference in rise/fall characteristics of the linearly and Blackman-gated tonebursts could account for any differences in ABR results at 4000 Hz. The ABR toneburst stimuli were calibrated behaviorally in 15 adults with normal hearing.

RESULTS

In the normal-hearing listeners toneburst-ABR thresholds generally exceeded behavioral thresholds by 10 to 13 dB for all stimuli. Correlations of 0.85 to 0.96 were obtained between 2000 and 4000 Hz toneburst ABR thresholds and pure-tone audiometric thresholds in the hearing-impaired listeners. Results were similar for Blackman- and linearly gated stimuli.

CONCLUSIONS

There were no clear differences between Blackman- and linearly gated tonebursts in terms of how well ABR thresholds predicted pure-tone thresholds at 2000 and 4000 Hz. In general audiometric thresholds were predicted with good accuracy (+/-15 dB) by the toneburst ABR thresholds. The 4000-Hz audiometric threshold was underestimated in one subject with a very steeply sloping hearing loss by both Blackman- and linearly gated toneburst ABR thresholds, indicating that ipsilateral masking such as notched noise would be needed to ensure frequency specificity in this and similar cases.

An investigation of the use of band-limited chirp stimuli to obtain the auditory brainstem response

Auditory brainstem responses (ABRs) using clicks enable global objective estimation of hearing threshold. Recently, it has been suggested that a chirp stimulus may produce a synchronous response from a larger portion of the basilar membrane than a click, and that a chirp will produce a greater amplitude response than a click at the same sensation level. Various workers have modified the stimulus to achieve frequency specificity (e.g. using tone-bursts). The present investigation used band-limited chirp stimuli having the same frequency-delay characteristics as the chirp mentioned above that compensate for frequency-dependent cochlear delays. The intention was to generate highly synchronized neural responses across parts of the nerve fibre array. Stimuli were presented at sensation levels between 10 and 50 dB to 10 adult subjects. Wave V was consistently identifiable even for low-frequency stimuli. Wave V amplitude increased and latency decreased as stimulus frequency increased. The latency decrease is consistent with high-frequency responses arising from basal regions of the cochlea. ABR thresholds were defined by objective estimation and visual inspection. Average ABR thresholds were 16 dB higher than behavioural thresholds for high-frequency chirps (3000-6000 Hz), increasing to 25 dB for low-frequency chirps (375-750 Hz). These ABR thresholds are closer to behavioural thresholds and have a smaller variance than reported for tone-burst stimuli without masking. However, they are not as close as those reported for tone-bursts in notched noise. The disadvantage of the band-limited chirps is that they have a wider spectral spread than tone-bursts and hence may elicit a response from unwanted frequency regions of the basilar membrane.

Assessment of hearing in infants with moderate to profound impairment: the Melbourne experience with auditory steady-state evoked potential testing

Auditory steady-state evoked potential (ASSEP) testing has been used in the assessment of hearing in infants at the University of Melbourne School of Audiology Clinic during the past 10 years. This study examines the evoked potential and behavioral hearing test findings for 200 children in whom permanent, moderate to profound hearing loss was diagnosed with the ASSEP procedure. The ASSEP audiograms were obtained with amplitude and frequency modulated tones at octave frequencies (500 to 4,000 Hz). In 184 infants, the hearing loss appeared to be of sensorineural origin. For these children, there was a strong correlation between ASSEP findings and behavioral thresholds, with Pearson r coefficients ranging from 0.81 to 0.93 with test frequency. As such, the ASSEP findings obtained in the first months of life were accurate enough to form a basis for fitting amplification and early intervention. For the 16 children whose hearing loss appeared to be the result of auditory neuropathy, however, ASSEP thresholds showed little or no relationship to the behavioral audiogram.

Frequency specificity of the human auditory brainstem and middle latency responses using notched noise masking

This study investigated the frequency specificity of the auditory brainstem and middle latency responses to 80 and 90 dB ppe SPL 500-Hz and 90 dB ppe SPL 2000-Hz tonebursts. The stimuli were brief (2-1-2 cycle) linear-gated tonebursts. ABR/MLRs were recorded using two electrode montages: (1) Cz-nape of neck and (2) Cz-ipsilateral earlobe. Cochlear contributions to ABR wave V-Na and MLR waves Na-Pa and Pa-Nb were assessed by plotting notched noise tuning curves which showed amplitudes and latencies as a function of center frequency of the noise masker [Abdala and Folsom, J. Acoust. Soc. Am. 97, 2394 (1995); ibid. 98, 921 (1995)]. Maxima in the response amplitude profiles for the ABR and MLR to 80 dB ppe SPL tonebursts occurred within one-half octave of the nominal stimulus frequency, with minimal contributions to the responses from frequencies greater than one octave away. At 90 dB ppe SPL, contributions came from a slightly broader frequency region for both stimulus frequencies. Thus, the ABR/MLR to 80 dB ppe SPL tonebursts shows good frequency specificity which decreases at 90 dB ppe SPL. No significant differences exist in frequency specificity of: (1) ABR wave V-Na versus MLR waves Na-Pa and Pa-Nb at either stimulus frequency or intensity; and (2) ABR/MLRs recorded using the two electrode montages.

Steady state responses to multiple amplitude-modulated tones: an optimized method to test frequency-specific thresholds in hearing-impaired children and normal-hearing subjects

OBJECTIVE

To evaluate, using statistical methods, the usefulness of the binaural multiple frequency auditory steady state responses (MF SSRs) for objective, frequency-specific audiometry in a large sample of hearing-impaired children and normal-hearing subjects.

DESIGN

The MF SSRs were recorded in a sample of 43 hearing-impaired children (86 ears) and 40 normal-hearing young adults (80 ears). Simultaneous carrier tones (0.5, 1, 2, and 4 kHz) modulated in amplitude at different rates (77 to 105 Hz) were presented binaurally (TDH 49 earphones) at variable intensities (110 to 20 dB SPL). For each subject the response thresholds (RTHs) at 0.5, 1, 2, and 4 kHz, were determined automatically (F test) and compared with the corresponding behavioral thresholds (BTHs).

RESULTS

In the normal-hearing subjects, RTHs were detectable, on average, between 11 and 15 dB above the BTH. These differences were significantly smaller in the hearing-impaired (5 to 13 dB). Also a close correspondence was found between the subjective and objective audiogram curves in both groups. The within subject Spearman correlation coefficients calculated between the two curves, were in most cases above the significance cut off point (p < 0.05). Also in 1-way repeated measures analysis of variance, the overall error in the estimation of the audiogram (vector across frequency of absolute distances between the curves) did not differ significantly from zero.

CONCLUSIONS

The binaural MF SSR was proven to be a valid technique for the estimation of an objective audiogram, in a large sample of hearing-impaired children and normal-hearing subjects. With this method, frequency-specific thresholds at 0.5, 1, 2, and 4 kHz could be determined in all subjects (and both ears) with no appreciable loss in accuracy and a considerable reduction in testing time (average recording time = 21 minutes) when compared with other frequency-specific techniques.