Özcan Özdamar

Auditory middle latency responses (MLRs) in patients with cortical lesions

Auditory middle latency response (MLRs) and auditory brain stem responses (ABRs) were simultaneously recorded in 24 patients with cortical lesions primarily affecting the temporal lobes. Site of lesion was documented by computerized tomography (CT) scan and behavioral profiles assessing language and other higher cortical functions were obtained. In patients with normal ABRs and either left or right hemisphere lesions, MLR components Na and Pa obtained at the vertex were of normal shape and latency. Exceptions to this occurred in 2 patients: one with bilateral temporal lobe lesions, the second with an infraventricular left temporal lobe lesion extending into the thalamic radiations. Although Na and Pa shape and latency were for the most part unaltered, Pa amplitude tended to cluster at the low end and below normal values. MLR recorded in the coronal plate showed Pa amplitude to be attenuated or absent over the damaged temporal lobe relative to the vertex or the intact hemisphere. This finding contrasts with data from normal subjects where Pa amplitude is largest at the vertex and essentially symmetrical about the temporal lobes. Patients showing an atypical amplitude distribution tended to have lesions involving auditory cortex and adjacent white matter projections. No obvious correlations between MLR abnormalities and behavioral findings regarding receptive and expressive language processes were found. Pa appears to be affected by temporal lobe lesions involving auditory cortex and thalamic projections. Our findings support the hypothesis that Pa is bilaterally generated by two symmetrical, vertically oriented dipole sources located about the temporal lobes.

Auditory Middle-Latency Responses in Humans

Middle-latency responses (MLR) in humans were studied using an unconventional recording technique with wide bandpass filters. Such filtering permitted simultaneous recording of the auditory brain stem response (ABR) thus facilitating comparisons between the two responses. Effects of sedation (chloral hydrate and diazepam), stimulus-related properties and the coronal distribution of MLRs were examined. Mild sedatives did not appear to affect either MLRs or ABRs. MLRs differed from ABRs in their stimulus-related properties, implying that the neuronal mechanisms underlying their generation are not the same. The amplitude of the MLR component, Pa, was largest at the vertex and symmetrically distributed over the temporal lobes. MLR components Na and Pa and ABR wave V were reliably obtained in all subjects at moderate and high stimulus intensities. At low stimulus levels, however, the detectability of wave V was more robust than the middle-latency components. Thus ABR appears to be the test of choice when hearing sensitivity is in question. MLRs are likely to be most clinically useful in patients with neurological or central auditory processing disorders.

Absent auditory brain stem response: Peripheral hearing loss or brain stem dysfunction?

Interpretation of auditory brain stem response (ABR) findings can be problematic in cases where waves III and V are absent. Such findings can be attributed to profound hearing loss, brain stem neuropathology, or both. Over a 3‐year period, 48 patients with no known brain stem damage and on whom audiologic data were available were found to have no response by ABR or absent waves III and V. Severe to profound hearing loss was documented in 38 cases, audiometric data were equivocal in 3 cases, and 7 patients showed pure tone sensitivity ranging from normal hearing to moderate impairment. Thus 15% had better hearing sensitivity than might have been expected from their ABR findings. Each of these patients also exhibited abnormal acoustic reflex findings. We report the electrophysiological (ABR, MLR, acoustic reflex}, medical (history, neurological, EEG, CT scan) and behavioral (audiometric, speech and language, learning disabilities, psychological) data which characterize this group of patients.

Auditory brain stem and middle latency responses in a patient with cortical deafness

Auditory brain stem (ABR) and middle latency responses (MLR) were recorded in a patient with bilateral temporal lobe lesions. Audiological and higher cortical functions were assessed using conventional behavioral methods. Roentgenological findings were presented for localizing the lesions. Initially the patient showed no behavioral response to sound. Subsequently the patient reported inconsistent awareness of environmental sounds and pure tone sensitivity was impaired to a severe degree. Higher cortical function was essentially intact and the patient was not aphasic. ABR and acoustic reflex findings were consistent with normal functioning of the auditory periphery and brain stem pathways. MLR component Pa was absent bilaterally. These findings suggest that MLR component is bilaterally generated in the temporal lobes. Auditory cortex appears to play a role in auditory sensitivity in humans.

Behavioral, compound action potential, and single unit thresholds: Relationship in normal and abnormal ears

Comparisons were made for two species (chinchilla and mongolian gerbil) among mean behavioral audiogram, mean just detectable action potential (AP) responses to tone bursts, and single-fiber response thresholds at the characteristic frequency, averaged in one-octave bands. In normal animals and in a group of Kayamycin-treated chinchillas, these mean measures appear to have a well-ordered relationship. Unit and AP thresholds are within 10 dB from one another throughout the frequency range. Behavioral thresholds are usually 15--20 dB more sensitive, but the three curves are roughly parallel except at the highest frequencies, where the behavioral threshold begins to increase approximately one-half octave above the physiological ones. Individual examples for four gerbils and four chinchillas having hair cell losses due to Kanamycin intoxication reinforce the notion based on mean data that in most cases AP thresholds can serve to predict the behavioral threshold configuration.

Input–output functions of cochlear whole‐nerve action potentials: Interpretation in terms of one population of neurons

It is commonly assumed that the two‐segmented input–output functions of the whole‐nerve action potential are a result of the activity of two sets of primary fibers: a low‐ and a high‐sensitivity group. While anatomical studies show the existence of two populations of fibers, there are no clear‐cut electrophysiological signs of two distinct populations responding with different thresholds. In light of this physiological result, it is desirable to construct a scheme for the growth of the whole‐nerve action potential that involves only one group of fibers. This can be done in a qualitative fashion by considering the pattern of single‐unit tuning curves and assessing the contribution of populations of units to the compound response. Thus the slowly growing low‐level segment of the input–output function is identified with the sharp tip region of the tuning curves of the responding units, while the high‐level, rapidly growing, segment is associated with the recruitment of higher‐frequency units that respond on ...

Follow-up of infants screened by auditory brainstem response in the neonatal intensive care unit

Auditory brainstem response screening at 40 and 60 dB was conducted in 100 infants in the neonatal intensive care unit to determine initial failure rate and prevalence of abnormality on follow-up. Of our NICU population, 20% failed one or both of the screening levels: 9% failed at 60 dB in both ears, and 11% failed at 40 dB in one or both ears. On follow-up, half of the 60 dB failure group were found to have sensorineural or conductive impairment and represent the 2% to 4% prevalence of serious otologic-audiologic problems generally found in an NICU population. Subsequent improvement (reversal) of the retest ABR records of the remaining infants in the 60 dB failure group was thought to be related to neural changes in the brainstem associated with recovery from hypoxic episodes. A transient or reversible conductive deficit appeared to account for the majority of failures at 40 dB. We recommend the screening protocol be expanded to include threshold and latency measures in infants who fail the initial screening. The transient nature of many ABR abnormalities makes postdischarge ABR, otologic, audiologic, and neurologic examinations mandatory before any inferences are made about hearing loss or neurodevelopmental disorders.

Generation of the 40-Hz auditory steady-state response (ASSR) explained using convolution.

OBJECTIVE In this study, the superposition theory of the 40-Hz auditory steady-state response (ASSR) generation is investigated using auditory brainstem response (ABR) and middle latency responses (MLRs) obtained with 40 Hz jittered sequences with the continuous loop averaging deconvolution (CLAD) algorithm. METHODS Click sequences at around 40 Hz with high (maximum length sequence), medium and low jitters were presented to normal hearing awake adult subjects monaurally. Overlapping MLR responses were deconvolved using the frequency domain CLAD method. In addition, conventional auditory MLRs at 4.88 Hz and ASSRs at 39.1 Hz were obtained in all subjects. Synthetic ASSRs were constructed using different rate and jitter MLRs as base recordings. Contributions of the primary components were investigated by wave elimination using phasors. RESULTS Findings indicate that the generation of the 40-Hz ASSRs can be explained successfully by the superposition of the ABR and MLR waves generated at that stimulation rate. N(a)-P(a) and N(b)-P(b) components of the MLR contribute about equally (45% each), while the wave V of the ABR contributes a lesser amount (10%). CONCLUSIONS Forty-Hertz ASSRs are composite responses generated by the superposition of the major waves of the ABR and the MLR. Dramatic amplitude increase of the ASSR at 40Hz is primarily due to the superposition of the resonating P(b) component to the P(a) wave. SIGNIFICANCE Several unexplained properties of the 40-Hz ASSR can be explained by the stimulus and brain state dependent characteristics of the slow ABR, the P(a) and the P(b) components of the MLR.

Deconvolution of evoked responses obtained at high stimulus rates

Continuous loop averaging deconvolution (CLAD) is a new general mathematical theory and method developed to deconvolve overlapping auditory evoked responses obtained at high stimulation rates. Using CLAD, arbitrary stimulus sequences are generated and averaged responses deconvolved. Until now, only a few special stimulus series such as maximum length sequences (MLS) and Legendre sequences (LGS) were capable of performing this task. A CLAD computer algorithm is developed and implemented in an evoked potential averaging system. Computer simulations are used to verify the theory and methodology. Auditory brainstem responses (ABR) and middle latency responses (MLR) are acquired from subjects with normal hearing at high stimulation rates to validate and show the feasibility of the CLAD technique.

Automated auditory brainstem response interpretation

The authors report a complete automated system for auditory brainstem response (ABR) identification and waveform recognition. The goal was to develop an automated analysis methodology that would facilitate the clinical use of auditory brainstem responses by reducing the time required to manually label and measure absolute and interpeak latencies. The system presented here accomplished this goal, supplying not only threshold information, but also additional diagnostically significant information. In addition, such an automated system will standardize the labeling process, which can vary depending on the labeling preference of individual clinicians. There are currently no commercially available systems capable of labeling ABR peaks or interpreting results originating from a wide range of stimulation intensities. The system developed in this study performs both peak labeling and assessment functions.<<ETX>>