Effects of click polarity on brainstem auditory-evoked potentials in cochlear hearing loss: a working hypothesis

Brain stem auditory potentials evoked by clicks in the presence of high-pass filtered noise in dogs

This study evaluates the effects of a high-frequency hearing loss simulated by the high-pass-noise masking method, on the click-evoked brain stem-evoked potentials (BAEP) characteristics in dogs. BAEP were obtained in response to rarefaction and condensation click stimuli from 60 dB normal hearing level (NHL, corresponding to 89 dB sound pressure level) to wave V threshold, using steps of 5 dB in eleven 58 to 80-day-old Beagle puppies. Responses were added, providing an equivalent to alternate polarity clicks, and subtracted, providing the rarefaction-condensation potential (RCDP). The procedure was repeated while constant level, high-pass filtered (HPF) noise was superposed to the click. Cut-off frequencies of the successively used filters were 8, 4, 2 and 1 kHz. For each condition, wave V and RCDP thresholds, and slope of the wave V latency-intensity curve (LIC) were collected. The intensity range at which RCDP could not be recorded (pre-RCDP range) was calculated. Compared with the no noise condition, the pre-RCDP range significantly diminished and the wave V threshold significantly increased when the superposed HPF noise reached the 4 kHz area. Wave V LIC slope became significantly steeper with the 2 kHz HPF noise. In this non-invasive model of high-frequency hearing loss, impaired hearing of frequencies from 8 kHz and above escaped detection through click BAEP study in dogs. Frequencies above 13 kHz were however not specifically addressed in this study.

Objective detection of brainstem auditory evoked potentials with a priori information from higher presentation levels

This paper describes a brainstem auditory evoked potentials (BAEPs) detection method based on supervised pattern recognition. A previously used pattern recognition technique relying on cross-correlation with a template was modified in order to include a priori information allowing detection accuracy. Reference is made to the patient's audiogram and to the latency-intensity (LI) curve with respect to physiological mechanisms. Flexible and adaptive constraints are introduced in the optimization procedure by means of eight rules. Several data samples were used in this study. The determination of parameters was performed through 270 BAEPs from 20 subjects with normal and high audiometric thresholds and through additional BAEPs from 123 normal ears and 14 ears showing prominent wave VI BAEPs. The evaluation of the detection performance was performed in two steps: first, the sensitivity, specificity and accuracy were estimated using 283 BAEPs from 20 subjects showing normal and high audiometric thresholds and secondly, the sensitivity, specificity and accuracy of the detection and the accuracy of the response threshold were estimated using 213 BAEPs from 18 patients in clinic. Taking into account some a priori information, the accuracy in BAEPs detection was enhanced from 76 to 90%. The patient response thresholds were determined with a mean error of 5 dB and a standard deviation error of 8.3 dB. Results were obtained using experimental data; therefore, they are promising for routine use in clinic.

Maturation of the auditory system in clinically normal puppies as reflected by the brain stem auditory-evoked potential wave V latency-intensity curve and rarefaction-condensation differential potentials

OBJECTIVE

To evaluate auditory maturation in puppies.

ANIMALS

Ten clinically normal Beagle puppies.

PROCEDURE

Puppies were examined repeatedly from days 11 to 36 after birth (8 measurements). Click-evoked brain stem auditory-evoked potentials (BAEP) were obtained in response to rarefaction and condensation click stimuli from 90 dB normal hearing level to wave V threshold, using steps of 10 dB. Responses were added, providing an equivalent to alternate polarity clicks, and subtracted, providing the rarefaction-condensation differential potential (RCDP). Steps of 5 dB were used to determine thresholds of RCDP and wave V. Slope of the low-intensity segment of the wave V latency-intensity curve was calculated. The intensity range at which RCDP could not be recorded (ie, pre-RCDP range) was calculated by subtracting the threshold of wave V from threshold of RCDP RESULTS: Slope of the wave V latency-intensity curve low-intensity segment evolved with age, changing from (mean +/- SD) -90.8 +/- 41.6 to -27.8 +/- 4.1 micros/dB. Similar results were obtained from days 23 through 36. The pre-RCDP range diminished as puppies became older, decreasing from 40.0 +/- 7.5 to 20.5 +/- 6.4 dB.

CONCLUSION AND CLINICAL RELEVANCE

Changes in slope of the latency-intensity curve with age suggest enlargement of the audible range of frequencies toward high frequencies up to the third week after birth. Decrease in the pre-RCDP range may indicate an increase of the audible range of frequencies toward low frequencies. Age-related reference values will assist clinicians in detecting hearing loss in puppies.

Auditory neuropathy with preserved cochlear microphonics and secondary loss of otoacoustic emissions

Auditory neuropathy is defined as absent or severely distorted auditory brainstem responses with preserved otoacoustic emissions and cochlear microphonics. This entity can be found in various circumstances including pre-lingual children. An almost universal characteristic reported from adult patients is the ineffectiveness of traditional hearing aids. Adequate management of pre-lingual cases therefore remains an open problem. This paper describes two pre-lingual children whose follow-up data demonstrated a selective loss of the otoacoustic emissions, whereas the cochlear microphonics remained preserved. In one of the patients, hearing aid fitting as soon as she lost her otoacoustic emissions proved successful. These findings have important implications for the operational definition of the condition, since one must be prepared to encounter cases with absent otoacoustic emissions. The present data also demonstrate that conventional amplification can benefit pre-lingual auditory neuropathy cases, at least once they have lost their otoacoustic emissions.

Auditory neuropathy: a report on three cases with early onsets and major neonatal illnesses

We report 3 children without any brainstem auditory evoked potential (BAEP) neural component who all retained isolated cochlear microphonic potentials as well as click-evoked otoacoustic emissions. Two of them demonstrated only moderately impaired audiometric thresholds. These features correspond to a peculiar pattern of auditory dysfunction recently coined "auditory neuropathy'. In contrast with the published previous cases of auditory neuropathy presenting with an acquired hearing deficit as children or young adults, all 3 children had a history of major neonatal illness and the auditory neuropathy was already demonstrated in the first months of their lives.