Biomedical subjects
Publications and source records attributed to D R Stapells.
One child in 750 is born with a handicapping hearing impairment. The methods available to screen and evaluate infants at risk (auditory brainstem responses, middle latency responses, and cortical auditory evoked potentials) are reviewed, explained, and illustrated with case histories.
The thresholds for the short-latency auditory evoked potentials (SLAEPs) to short-duration tones presented in notched-noise masking were evaluated in 20 normal-hearing and 20 hearing-impaired subjects. The differences (dB) between these thresholds (dB nHL) and the pure-tone behavioral thresholds (dB HL) across all 40 subjects were 11.6, 6.1, 6.3 and 0.8 dB for 500, 1,000, 2,000 and 4,000 Hz, respectively. These differences were significantly smaller for the hearing-impaired subjects than for the normal-hearing subjects. Ninety-eight percent of the SLAEP threshold estimations were within 30 dB of the subjects' pure-tone behavioral thresholds and 91% were within 20 dB.
The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were recorded from 48 infants with ears exhibiting various external and middle ear states (normal, otitis media, auditory meatal atresia). Amplitudes were greater, wave V latencies longer, and detectability better for responses to 500-Hz BC tones compared to 2,000-Hz BC tones. Overall, most (94% to 100%) infants with normal cochlear sensitivity demonstrate ABRs to 20-dB normal hearing level (nHL) 500-Hz BC tones and 30-dB nHL 2,000-Hz BC tones. In cases in which masking is difficult (eg, bilateral atresia), infant ipsilateral/contralateral ABR asymmetries may help determine from which cochlea a response to the BC tones originates. In conclusion, two-channel ABR recordings to BC tones appear to be feasible for demonstrating normal cochlear sensitivity in infants.
The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.
These experiments add a measure of response phase variance--'phase coherence'--to the analysis procedures applied to auditory steady-state responses (SSR). The effects of stimulus frequency, intensity, rate and total number (i.e., recording time) were studied using 11 normal adult subjects. In a first experiment, SSR phase coherence was found to be highest at presentation rates near 40/sec, even when response amplitudes were higher at other rates. Further, phase coherence was observed to be linearly related (r = 0.91) to signal-to-noise ratio. Two further experiments demonstrated that phase coherence can correctly detect responses to near-threshold stimuli. In 15 min runs, significant phase coherence was detected within 6 dB of behavioral threshold in 6 subjects for 0.5 and 2.0 kHz signals, while phase coherence in no-stimulus control runs did not reach significance. Minimum data collection time required to record significant (P less than 0.01) responses was studied for 10 subjects. In 2 of 40 recordings at 10 dB SL phase coherence remained insignificant after even 15 min. However, average recording time to reach significance at 10 dB SL was less than 4 min in 38 of 40 recordings, and less than 1 min at 25 dB SL (18 of 18 recordings). These results indicate that using phase coherence to detect the presence of the 40/sec auditory steady-state response, efficient threshold search procedures may be devised to provide fast, accurate, and objective estimates of auditory behavioral thresholds in nearly all normal adults.
This paper evaluates the normal hearing thresholds for clicks and assesses the effects on these thresholds of varying the duration of the listening period and the presentation rate, polarity, and symmetry of the clicks. There were no significant changes in thresholds as the listening period decreased from 2s to 300 mg. There was, however, a 2.5 dB increase in threshold at the listening period decreased from 300 to 100 ms. Increase stimulus presentation rate from 5 to 80/s decreased threshold 4.5 dB per tenfold change in rate. There were no significant differences in threshold between rarefaction and condensation clicks. The average threshold obtained from 40 normal young adults using 100-microseconds square-wave clicks presented through a TDH-49 earphone at 10/s was 36.4-dB peak SPL or 29.9 peak equivalent SPL. Neither peak SPL nor peak equivalent SPL measurements gave consistent thresholds for clicks with different degrees of symmetry. A root-mean-square measure of the pressure over the initial millisecond-SPL(1 ms)-gave a threshold of 25.6 dB. This SPL(1ms) measure of threshold proved to be far more consistent for clicks with different degrees of symmetry than either the peak SPL or the peak equivalent SPL measures.
Auditory evoked potentials generated in the cochlea and the brainstem can be recorded from the human scalp. These potentials generally have a latency of less than 15 ms and an amplitude of less than 2 microV. They are, nevertheless, relatively easy to record using averaging, provided that appropriate attention is paid to the frequency band-pass of the amplifier-filters and to the locations of the recording electrodes. The responses are precisely determined by a variety of stimulus factors such as intensity and frequency, and by many subject parameters such as age and sex. This paper considers the anatomical and physiological principles underlying these relationships.
Auditory middle latency and steady-state responses (MLR/SSRs) were recorded in normal infants (aged 3 weeks to 28 months) and adults. SSR amplitudes were maximum using stimulus presentation rates near 40 Hz in adults. By contrast, the infant data showed no consistent amplitude maximum across the rates tested (9-59 Hz). With the exception of the brain-stem response wave V to MLR Na deflection, MLR components in infants' responses to 10.85 Hz clicks did not show any consistent pattern. To investigate the hypothesis that the 40 Hz SSR is derived from overlapping of the 10 Hz MLR components, 43.4 Hz SSRs were synthesized from the responses recorded at 10.85 Hz and compared with those recorded at 43.4 Hz. The predictive accuracy of the synthesized 43.4 Hz SSRs was significantly better in adults than in infants. The results of these studies indicate the presence of large age-related differences in the auditory MLR and SSR, and in the relationship between the two responses.
The brainstem response to brief tones contains a large vertex-positive component. If high-pass filter settings above 20 Hz are used, particularly with high rolloff slopes, the morphology of the response changes so that a vertex-negative wave becomes the most prominent component of the response. The amplitude of the response is unaffected by stimulus presentation rates of up to 35/sec. Tones with longer rise times have greater frequency specificity, but at rise times of greater than 5 msec, the brainstem response becomes very small. At high intensities, regardless of the rise time, the response to tones is not completely frequency specific, and notched noise masking should be used to obtain frequency-specific responses.
The auditory steady state potentials may be an important technique in objective audiometry. The effects of stimulus rate, intensity, and tonal frequency on these potentials were investigated using both signal averaging and on-line Fourier analysis. Stimulus presentation rates of 40 to 45/sec result in a 40 Hz sinusoidal response which is about twice the amplitude of the 10 and 60/sec responses. No significant effects of subject age or sex were seen. The 40/sec response shows a linear decrease in amplitude and a linear increase in latency when stimulus intensity is decreased from 90 to 20 dB normal hearing level. This response is recordable to within a few decibels of behavioral threshold. Stimuli of different tonal frequency give similar amplitude/rate functions, with absolute amplitude decreasing with increasing tonal frequency. Signal averaging and Fourier analysis provide nearly identical amplitude/rate, amplitude/intensity, and latency/intensity functions. Both methods of analysis may be used, therefore, to record the 40 Hz steady state potential. Fourier analysis, however, may be the faster and less expensive method. Furthermore, techniques ("zoom") are available with Fourier analysis to study the effects of varying stimulus parameters on-line with the Fourier analysis procedure.
This review paper briefly considers how stimulus, noise masking and recording parameters affect the frequency and place specificity of auditory brainstem responses (ABRs) to air- and bone-conducted stimuli. Issues concerning the use of clicks for ABR threshold estimates will first be presented, followed by results for tone-evoked ABR thresholds and how well they predict the pure-tone behavioral audiogram. Noise-masking options (e.g. high-pass noise, notched noise and white noise) to improve the frequency specificity of tone-evoked ABRs, which are now available on clinical ABR units, will also be discussed. The goal of this article is to demonstrate that ABRs to tonal stimuli can be successfully recorded in most clinical environments and can provide reasonably accurate estimates of 500- to 4000-Hz pure-tone behavioral thresholds in infants, children and adults. Specific parameters and protocols for obtaining frequency-specific ABR threshold responses are provided.