Assessing menstrual cycles with urinary hormone assays.

The Study of Women's Health Across the Nation (SWAN) is a multiethnic cohort study of middle-aged women enrolled at seven US sites. A subset of 848 women completed a substudy in which their urinary gonadotropins and sex steroid metabolites were assessed during one complete menstrual cycle or up to 50 consecutive days. Urine was analyzed for LH, FSH, estrone conjugates (E1c), and pregnanediol glucuronide (Pdg). To prepare for serial analysis of this large, longitudinal database in a population of reproductively aging women, we examined the performance of algorithms designed to identify features of the normal menstrual cycle in midreproductive life. Algorithms were based on existing methods and were compared with a "gold standard" of ratings of trained observers on a subset of 396 cycles from the first collection of Daily Hormone Substudy samples. In evaluating luteal status, overall agreement between and within raters was high. Only 17 of the 396 cycles evaluated were considered indeterminate. Of the 328 cycles rated as containing evidence of luteal activity (ELA), 320 were considered ELA by use of a Pdg threshold detection algorithm. Of 51 cycles that were rated as no evidence of luteal activity, only 2 were identified by this algorithm as ELA. Evaluation of the day of the luteal transition with methods that detected a change in the ratio of E1c to Pdg provided 85-92% agreement for day of the luteal transition within 3 days of the raters. Adding further conditions to the algorithm increased agreement only slightly, by 1-8%. We conclude that reliable, robust, and relatively simple objective methods of evaluation of the probability and timing of ovulation can be used with urinary hormonal assays in early perimenopausal women.

Click lateralization is related to the beta component of the dichotic brainstem auditory evoked potentials of human subjects.

The changes in perception and in the binaural difference waveform (BD) for dichotic clicks with interaural time and level differences (ITDs and ILDs) are compared. Only beta, the first major peak of the BD, correlated with the perceptual measurements. Whenever beta is clearly present, the clicks are perceived as a unitary fused image. Whenever the clicks are perceived as not fused, beta is undetectable by our methods. The amplitude of beta remains nearly constant as the ITD is increased to about 1 ms, while the click's position is perceived as moving from midline toward the leading ear. Over about the next 0.2 ms, beta becomes undetectable, as the image stops moving and loses its fused quality. As the ILD is increased, beta amplitude decreases gradually, while the image remains unitary and moves toward the unattenuated earphone. Thus beta becomes undetectable for ILDs of 30 to 35 dB, and the dichotic clicks become indistinguishable from monotic clicks for ILDs of 44 to 53 dB. The ITD and ILD matching curve for beta latency is similar to the ITD and ILD psychophysical matching curve for lateralization. These results suggest that beta is a physiological correlate of the categorical percept, binaural fusion, and is generated by a brainstem structure essential for the preception of click lateralization.

Use of intraoperative auditory evoked potentials to preserve hearing in unilateral acoustic neuroma removal.

Twenty-two patients with unilateral acoustic neuromas and preoperative speech discrimination scores of 35% or more had intraoperative monitoring of the electrocochleogram (ECoG) using a transtympanic electrode, and of the brain-stem auditory evoked potentials (BAEP's) using scalp electrodes. Rapid feedback was provided about the status of the cochlear microphonics from the hair cells of the inner ear (CM of the ECoG), the compound action potential of the auditory nerve (N-1 of the ECoG or Wave I of the BAEP's) and the potentials from the lower brain stem (Wave V of the BAEP's). All patients had total removal of the tumor. In 21, the cochlear nerve was anatomically preserved, and 20 had good postoperative facial nerve function. Correlation of tumor size with postoperative hearing was as follows: discrimination scores of more than 35% in three of four patients with 1-cm tumors, two of eight with 1.5-cm tumors, two of six with 2- to 2.5-cm tumors, and one of four with tumors of 3 cm or more. Two other patients with 1.5-cm tumors had discrimination scores of less than 35%, and one patient with a 2-cm tumor had only sound perception. In two patients, the discrimination scores improved. At the end of the operation, all patients with hearing had a detectable N-1, and, when recorded, CM. All but one patient with no hearing had lost N-1, and CM was absent or reduced. Unless Wave V was unchanged, it was a poor predictor of postoperative hearing, and its absence did not preclude preservation of good hearing. The electrophysiological changes during each stage of the operation were analyzed and correlated with events during surgery. Areas in which there was an increased risk of loss of the potentials were determined. In some patients monitoring was unnecessary, because either there were no significant changes or the changes were abrupt and no recovery occurred. However, in other patients, monitoring alerted the surgeon to a possible problem and the method of dissection was altered. Possible mechanisms of hearing loss were suggested from the changes in the recordings.

Monitoring auditory evoked potentials during acoustic neuroma surgery. Insights into the mechanism of the hearing loss.

By recording cochlear, auditory nerve, and brainstem potentials while monitoring acoustic neuroma (vestibular schwannoma) surgery, different patterns of changes occur that suggest different causes for the hearing loss. Having identified the putative mechanism of the hearing loss, suggestions are made about how such hearing loss might be avoided.

Right-left asymmetries in the human brain stem: auditory evoked potentials.

Right-left asymmetries were found in the amplitudes (but not latencies) of 3 peaks of the brain stem auditory evoked potentials: most consistently in III(+), but also in I(-) and IV(+). In all 3 cases the mean amplitude was significantly larger for right ear stimulation than for left. The similarity between the distribution of cerebral dominance and the asymmetry of peaks III(+) and IV(+) suggests the possibility that cerebral asymmetries for language are related to asymmetries in the brain stem auditory system.