Auditory brainstem responses to single-slope stimuli. The influence of steepness and polarity

Comparison of 3 ABR Methods for Diagnosis of Retrocochlear Hearing Impairment

BACKGROUND The purpose of this study was to compare the effectiveness of methods for screening for retrocochlear pathologies based on auditory evoked brainstem responses (ABRs). The study compared the sensitivity, specificity, and effectiveness of these 3 techniques. MATERIAL AND METHODS The methods were: (i) standard ABR utilizing click-evoked responses, (ii) stacked ABR based on derived-band responses, and (iii) ABRs evoked by tone-pips (ABR TP). The methods were tested on patients with retrocochlear pathologies confirmed by MRI-Gd, normal-hearing subjects, and patients with cochlear hearing loss. The system and software used in the tests was NavPro AEP v.6.2.0 (BioLogic - Natus). Prior to testing, all subjects were given comprehensive audiologic and otologic examinations, including MR imaging. Sensitivity and specificity functions and predictive values of methods were determined. RESULTS The stacked ABR method as realized in the NavPro system exhibited high sensitivity but specificity was very low, due to the high variability of stacked ABR amplitudes. The standard ABR method had good specificity, but low sensitivity in cases of small tumors (below 1 cm in diameter). Best sensitivity and specificity was obtained with the ABR TP method. CONCLUSIONS The stacked ABR method allows small acoustic tumors to be detected, but produces high percentage of false positive results. The ABR TP method offers good sensitivity and specificity, and relatively high predictive value. The best option would be to use a two-stage screening, consisting of a standard ABR in the first stage and an ABR TP test in the second.

Polarity stimulation effects on brainstem auditory evoked potentials

Brainstem Auditory Evoked Potentials are considered exogenous potentials, that is, the responses obtained are highly dependent upon the characteristic of the stimulus used to evoke them.

AIM

To investigate the influence of the click stimulus polarity in the study of Brainstem Evoked Response Audiometry (BERA) at different intensities, using insertion-canal earphones.

TYPE OF STUDY

Clinical.

MATERIALS AND METHODS

33 individuals, aged between 18 and 28, with no auditory alteration were submitted to BERA testing, with click stimulus on the rarefaction, condensation and alternate polarities, in different intensities.

RESULTS

The absolute latencies of the V wave proved to be lower in the rarefaction polarity when compared to the others and, at 80 dBnHL, there was a significant difference between rarefaction and the other polarities for interpeak latencies III-V and I-V. There was a high correlation between the condensation and alternating polarities for absolute and interpeak latencies at 80 dBnHL.

CONCLUSION

the click stimulus polarity has a significant influence on BERA. In the routine use of the TDH 39 earphone, with alternating polarity, we suggest that condensation polarity is more adequate for standardized comparison purposes, due to the higher similarity of the latencies found in this insertion earphone study.

A new descriptor of the dual character of the input-output behaviour of the cochlea, with implications for signal-to-noise ratio estimation of brain-stem auditory potentials evoked by alternating polarity clicks

The signal-to-noise ratio based on a plus-minus average for residual noise estimation has been systematically computed for brain-stem auditory evoked potentials (BAEPs) evoked by alternating polarity clicks from threshold up to 100 dB nHL in subjects with normal cochlear function. The plus-minus averages have exhibited a systematic dual behaviour in close correspondence with the "L" and "H" portions of the latency-intensity functions: from threshold up to 50 dB SL ("L" segment) they faithfully reflect the post-averaging residual noise. From 50 dB SL upwards the plus-minus averages are contaminated by a signal identified as the differential potential between rarefaction and condensation responses. The plus-minus average is therefore an unreliable indicator of the post-averaging residual noise when alternating polarity clicks louder than 50 dB are used. These findings suggest that for intensities corresponding to the "L" (steep) part of the latency-intensity function, when inner hair cell excitation is dependent on active amplification by the outer hair cells, no difference exists between rarefaction and condensation responses. By contrast, once levels at which the inner hair cells can be directly stimulated are reached, responses to rarefaction and condensation clicks become different.