David L. McPherson

Binaural interaction in auditory evoked potentials: brainstem, middle- and long-latency components

Binaural interaction occurs in the auditory evoked potentials when the sum of the monaural auditory evoked potentials are not equivalent to the binaural evoked auditory potentials. Binaural interaction of the early- (0-10 ms), middle- (10-50 ms) and long-latency (50-200 ms) auditory evoked potentials was studied in 17 normal young adults. For the early components, binaural interaction was maximal at 7.35 ms accounting for a reduction of 21% of the amplitude of the binaural evoked potentials. For the middle latency auditory evoked potentials, binaural interaction was maximal at 39.6 ms accounting for a reduction of 48% of the binaural evoked potential. For the long-latency auditory evoked potentials, binaural interaction was maximal at 145 ms accounting for a reduction of 38% of the binaural evoked potential. In all of the auditory evoked potentials binaural interaction was long lasting around the maxima. The binaural interaction component extends for several milliseconds in the brainstem to tens of milliseconds in the middle- and long-latency components. Binaural interaction takes the form of a reduction of amplitude of the binaural evoked potential relative to the sum of the monaural responses, suggests that inhibitory processes are represented in binaural interaction using evoked potentials. Binaural processing in the auditory pathway is maximal in the time domain of the middle-latency components reflecting activity in the thalamo-cortical portions of the auditory pathways.

Binaural interaction of the auditory brain-stem potentials and middle latency auditory evoked potentials in infants and adults.

Binaural interactions in brain-stem auditory evoked potentials and in middle latency auditory evoked potentials were studied in 18 normal hearing adults and 10 normal term infants. Binaural interactions at the times of ABR waves V and VI were comparable in term infants and adults. Binaural interaction during the time domain of the middle latency auditory evoked potentials was the greatest at N20 in term infants and at N40 in adults. Measurement of binaural interaction during maturation may be a useful tool in assessing neurologically affected infants.

Long-term neurophysiologic outcome after neonatal extracorporeal membrane oxygenation**

We examined clinical and neurophysiologic measures in 10 children 4 to 9 years after neonatal extracorporeal membrane oxygenation. Electroencephalograms did not correlate with clinical or other neurophysiologic measures of interhemispheric asymmetry. By ultrasound imaging, the right internal carotid artery velocity was approximately 62% of that on the left, and right internal carotid flow was reduced by 74% (p less than or equal to 0.01), whereas an age-matched control group showed no differences. A decrease in the amplitude of the long-latency auditory and somatosensory evoked potentials was noted over the right hemisphere after left-sided stimulation compared with the left hemispheric potentials after right-sided stimulation (p less than or equal to 0.005). No significant differences in hemispheric symmetry were noted in the amplitudes for wave V of the auditory brain-stem response or in the P30 component of the middle-latency auditory evoked potentials. Likewise, latency measures of the evoked potentials were symmetric. We conclude that (1) neonatal extracorporeal membrane oxygenation is associated with long-lasting decreased right internal carotid blood flow with compensatory increased flow through the left carotid system and (2) there is a consistent reduction in the amplitude of right hemispheric long-latency evoked potentials. These latter findings may reflect redirected cerebral blood flow patterns after extracorporeal membrane oxygenation.

Auditory time-intensity cues in the binaural interaction component of the auditory evoked potentials

Binaural interaction in the brainstem and middle latency auditory evoked potentials to intensity (dI) and timing differences (dT) between the two ears was studied in 10 normal hearing young adults. A component reflecting binaural interaction in the brainstem potentials occurred at approximately 7 ms and was of largest amplitude when dI and dT were 0. The latency of the binaural interaction component gradually shifted and its amplitude decreased as dI or dT increased and binaural interaction became undetectable when dI = 16 dB or when dT > or = 1.6 ms. In the middle latency potentials binaural interaction components peaking at 20, 32, and 45 ms were defined that were also largest when dI and dT = 0. The latency of the interaction did not shift with changes in dT and dI whereas the amplitude gradually decreased but binaural interaction components were still evident even at the largest values of dI (30 dB) and dT (3 ms). Psychophysical judgments of binaural perceptions showed binaural fusion of the stimuli to persist with dT values up to 1.6 ms and that lateralization of the intracranial image was complete when either dT = 1.6 ms or when dI = 16 dB. The results suggest that the presence of a binaural interaction component of auditory brainstem potentials correlates with the fusion of binaural click stimuli and the amplitude of the binaural interaction component correlates inversely with the degree of lateralization of the intracranial image. Binaural interaction components of middle latency potentials persist and continue to change even after the binaural stimuli cannot be fused.

Experimentally induced round window membrane lesions.

This investigation confirmed previous studies indicating that the middle and inner ear of the guinea pig have a pronounced tendency to healing. Middle ear hemorrhage of surgical origin appears to stop quickly in the guinea pig. A surgically created perforation of the round window with or without removal of perilymphatic fluid by suction resulted in a spontaneous healing of the round window membrane in 12/13 animals. Perilymphatic hemorrhage, associated with short post-surgical interval was found in a substantial number of cases. The origin of the perilymphatic hemorrhage is doubtful. Degeneration of the organ of Corti was found in four ears in three animals and appeared to be correlated to the perilymphatic hemorrhage. Electrophysiological measurements appeared to correlate well with the anatomical findings for one animal with very small changes and for three animals with pronounced middle and inner ear pathology. In three additional animals less agreement was observed. In general these animals showed a more pronounced decrease of function than would be expected by the anatomy.

Psychometrically equivalent Russian speech audiometry materials by male and female talkers

Despite the large number of individuals who speak Russian, only a limited number of high-quality speech audiometry materials are available in a standard dialect of Russian. Thus, the purpose of this study was to develop and evaluate speech audiometry materials that can be used to measure word recognition and SRT testing in quiet for native speakers of Russian. Familiar monosyllabic and bisyllabic words were digitally recorded by male and female talkers of Russian and subsequently evaluated by native listeners. Using logistic regression, psychometric functions were then calculated for all words. Selected monosyllabic words were digitally adjusted to create word recognition lists which are relatively homogeneous with respect to audibility and psychometric slope. Speech reception threshold materials were developed by selecting twenty-five bisyllabic words with relatively steep psychometric function slopes (12.1%/dB and 9.9 %/dB) and digitally equating their intensity to match the mean PTA of the native listeners. Digital recordings of the resulting psychometrically equivalent speech audiometry materials are available on compact disc.

Electrophysiologic studies in selective dorsal rhizotomy for spasticity in children with cerebral palsy

A group of 20 children with spastic cerebral palsy underwent selective dorsal rhizotomy for alleviation of spasticity. Pre- and postoperatively, cortical somatosensory evoked responses (cSSEP), H reflex and F wave studies were done. Clinically there was dramatic reduction of tone without noticeable sensory loss. The electrophysiologic studies showed several findings: (1) many children have abnormal cSSEP preoperatively; (2) surgery seldom leads to a loss of cSSEP; (3) in many patients, there is a noteworthy improvement in the cSSEP wave form; (4) some children have electrophysiologic evidence of spinal cord dysfunction preoperatively and (5) Hmax/Mmax ratio decreases after surgery confirming decrease in tone.

Experimental aural barotrauma. Electrophysiological and morphological findings.

The electrophysiological findings show a time and pressure related decrease in function of the CM and the N1 potentials. Sudden changes were correlated with tympanic membrane perforations. Some of the decreased function is accounted for by middle ear effusion and hemorrhages, reducing mechanically the transmission of sound energy through the middle ear. This was evidenced by an improvement of function when the fluids were removed. Remaining decreases in function were interpreted as a result of influences on the inner ear function or of undisclosed middle ear changes. No differences were noted in cochlear function between animals subjected to sustained or intermittent middle ear pressures. Neither were any morphological differences noted between these two groups in the middle or inner ear. The morphological middle ear findings correlated well with previous clinically and experimentally induced changes with increased/decreased middle ear pressure. The cochlear findings include the interesting observation of an intact round window membrane, a clear endolymph, and a normal Organ of Corti in all cases. Positive findings were a high frequency of hemorrhage, most commonly demonstrated in the scala tympani of the basal turn close to the round window. The origin of the hemorrhages could not be demonstrated with the present investigation. The hemorrhages often appeared to be related to the cochlear aqueduct. The occurrence of hemorrhage was clearly related to increased negative pressure, and the non-existence of hemorrhage was always related to either tympanic membrane perforations or low applied pressure. Further frequent findings were distention, collapse, and rupture of the inner ear membranes which must be interpreted with great circumspection due to the method used. Likewise, some of the pathological cochlear findings may be due to pathological conditions which are not necessarily related to induced middle ear pressure.

Cerebral cortical contributions to sensory evoked potentials: hydranencephaly

The contribution of the cerebral cortex to the generation of sensory evoked potentials was studied in an infant with hydranencephaly. On CT scan no tissue above the thalamus was noted. Long-latency potentials to auditory stimuli were absent whereas the short-latency or brain-stem auditory evoked potentials and some of the components of the middle latency auditory evoked potentials (No and Po) were present. To visual stimulation only the electroretinogram was detected. To somatosensory stimulation only the spinal cord potentials could be detected. The absence of long-latency components in each of the sensory modalities supports the concept that these potentials require intact cerebral hemispheres in man.

Auditory brainstem response in infant hydrocephalus

Fifteen infants with hydrocephalus ranging in age from 32 to 43 weeks from conception were studied. The auditory brainstem response (ABR) was measured 48 h prior to the placement of a CSF shunt and within 5 days following shunt insertion. Results of this study showed a general improvement in the ABR following placement of the shunt. No consistent patterns were observed that allowed a clear explanation of the cause and effect of the abnormal ABR. However, the changes seen in the ABR are caused by increased CSF pressure, which may compress the transmission fibers, and generators of the ABR producing a type of neuropraxis. Early shunting appears to have a better outcome on the ABR than later shunting.