Electrically evoked auditory brainstem response in cochlear implant users.

The waveforms and parameters of electrically evoked auditory brainstem responses, eeABRs, registered in cochlear implant users, were compared with those of acoustically evoked auditory brainstem responses, aeABRs, recorded in normally hearing subjects. The eeABRs, in contrast to the aeABRs, contained dubious Wave IV, while missed Waves VI and VII. The eeABRs possessed also shorter peak-latencies, shorter inter-peak intervals, and greater amplitudes. The revealed differences have been explained by the lack of cochlear mechanisms in cochlear implant recipients. On the other hand, eeABRs and aeABRs exhibited similar stimulus intensity dependence. Both had also lower thresholds, shorter peak-latencies, and greater amplitudes in females than in males.

[Discrimination of musical pitch with cochlear implants]. / Diskrimination musikalischer Tonhöhen bei Patienten mit Kochleaimplantat.

BACKGROUND: Numerous people with cochlear implants (CI) report difficulties in listening to music even though they understand speech quite well. One reason for this is a limited perception of pitch and timbre. In this study ability of adult CI subjects to discriminate musical pitch is investigated. PATIENTS AND METHODS: In two psychoacoustic experiments, each conducted in 10 adult CI subjects provided with MED-EL Combi 40+ cochlear implant devices and a control group of subjects with normal hearing, individual discrimination abilities for musical pitch perception were determined. To investigate the influence of the group of instruments on discrimination ability, stimuli representing four different groups of instruments were used: woodwind (clarinet), brass (trumpet), strings (violin) and keyboard instruments (piano). RESULTS: The discrimination thresholds determined varied between individual CI subjects, and on average they were significantly higher for the piano than for the other three instruments. CONCLUSIONS: The results show that in subjects with CI pitch perception differs from instrument to instrument and is in general worse than in persons with normal hearing.

[Vestibular evoked muscle potentials dependency on neural origin and the location of an acoustic neuroma]. / Die vestibulär evozierten Muskelpotenziale in Abhängigkeit vom nervalen Ursprung und der Lage eines Akustikusneurinoms.

INTRODUCTION: Most acoustic neuromas (AN) originate from the inferior vestibular nerve (IVN). Vestibular evoked myogenic potentials (VEMP) are accepted as the only unilateral test for the function of the sacculus and the IVN. METHODS: The influence of the origin from the IVN and superior vestibular nerve (SVN), and the position of the AN in relation to the internal auditory canal on VEMPs was investigated. A total of 39 patients (aged: 30-67 years, mean: 53 years) were examined. The VEMPs were recorded on the activated sternocleidomastoid muscle and averaged over 200 stimuli. Tone bursts (95 dB nHL; 500 Hz; stimulation rate 5 Hz) were used to generate the VEMPs. RESULTS: The exact origin of the AN from the SVN or the IVN could be determined intraoperatively and correlated using VEMP in 28 patients. CONCLUSION: The origin of the AN has only a marginal influence on the results of VEMP measurements. The position of the AN in relation to the internal auditory canal seems to have more influence than the origin.

[Amplitude modulation following responses in audiological diagnostics]. / Amplitude Modulation Following Responses (AMFR) in der audiologischen Diagnostik.

The registration of brainstem potentials currently represents one of the most common methods in objective audiological diagnostics. However, regardless of their use, they are still known to possess important disadvantages, such as low specificity and validity in the lower frequency range due to broadband stimuli, or uncertainties due to the need for subjective evaluation. One potential solution to these problems could involve the registration of amplitude modulation following responses (AMFR). These potentials are being discussed much more regularly within the anglo-american literature due to their known frequency specificity within the high frequency range (resulting from a very narrow frequency band of stimulation), and also their ability to permit assessment of the hearing threshold at lower frequencies. Another additional advantage of AMFR results from the simple statistical verification of its presence.Extensive studies on the influence of both stimulating and recording parameters have also shown that the registration of AMFR could prove to be a very promising audiological tool, with past interest being focussed primarily on the optimal modulation frequency, the influence of vigilance of the generation of potentials, and the precise assessment of an objective threshold.

Linear versus non-linear recordings of transiently-evoked otoacoustic emissions--methodological considerations.

A non-linear technique is predominantly used for the recording of transiently-evoked otoacoustic emissions (TEOAEs). The aim of this study was to compare linear and non-linear TEOAE recordings. TEOAEs were recorded in 22 normal hearing subjects to clicks from 90 to 30 dB SPL in 10 dB steps with the ILO88 system using both linear and non-linear recording techniques. The non-linear recording technique reduces stimulus artifacts for early latencies, but total elimination could not be proved. Both artifact reduction and significant differences between the two kinds of TEOAE recordings were reduced for longer latencies and lower stimulus intensities. For longer latencies (>10 ms) there was no significant difference between "linear" and "non-linear" TEOAEs. A higher signal-to-noise ratio was found for "linear" TEOAEs, resulting in better identification and a higher test-retest correlation. The linear recording technique, which includes new methods of artifact cancellation in comparison to the mainly utilized non-linear recording technique, should be used especially in hearing screening.

Amplitude modulation following responses in awake and sleeping humans--a comparison for 40 Hz and 80 Hz modulation frequency.

There have been several studies, which suggest that the amplitude of amplitude modulation following responses (AMFR) is correlated to the state of vigilance, similar to the 40 Hz event-related potentials. The aim of the present study was to compare the dependency of the AMFR-amplitude from the state of sleep for 40 Hz and 80 Hz modulation frequency. Eight normal hearing adults were investigated during natural and drug-induced sleep. The stimuli used were sinusoidally amplitude-modulated tones of 1 kHz carried frequency and 40 or 80 Hz modulation frequency at 60 dB nH stimulation level. For 40 Hz modulation frequency an increase of EEG-activity in the Delta-and Theta-band during periods of sleep correlates significantly with a decreased AMFR-amplitude whereas for 80 Hz no significant relation between stage of sleep and AMFR-amplitude could be found. The results suggest that in audiological use of 40 Hz-AMFR the state of vigilance should be monitored and stabilized at a high level.

[Dependence of "amplitude modulation following response" on attention]. / Zur Abhängigkeit der "amplitude modulation following response" von der Vigilanz.

BACKGROUND AND OBJECTIVE: Amplitude modulation following responses (AMFR) allows good estimation of the hearing threshold due to the very narrow band excitation of the cochlea. Audiological use of AMFR requires knowledge of the relationship of these responses to the state of vigilance. The few studies published compared only qualitatively the amplitude of AMFR recorded in awake subjects to that recorded in sleeping subjects. A quantitative determination of the level of vigilance on the basis of recorded physiological parameters has not yet been carried out. In the present study, the relationship between the amplitude of AMFR and the level of vigilance was investigated quantitatively. PATIENTS/METHODS: In eight adults with normal hearing, the relationship between the AMFR amplitude and EEG amplitude in the delta- and theta-band was determined. The amplitude in both frequency bands was used to indicate the state of vigilance. The subjects were studied during natural and drug-induced sleep. A 1-kHz carrier tone with a sinusoidally modulated amplitude of 40 Hz or 80 Hz was used as stimulus. RESULTS: At 40-Hz modulation frequency, the AMFR amplitude correlates with the EEG amplitude both in natural and drug-induced sleep. An increase in EEG activity is paralleled by a significant reduction of AMFR amplitude. At 80-Hz modulation frequency, no relationship between AMFR amplitude and EEG activity could be detected. Under all conditions, the amplitudes of AMFR evoked by a modulation frequency of 80 Hz were significantly lower than those evoked by 40 Hz. CONCLUSIONS: These results suggest that for an audiological use of the 40-Hz AMFR the state of vigilance should be stabilised at a constantly high level. In spite of the lower influence of vigilance on the 80-Hz AMFR, this response appears less ideal for threshold estimation in adults due to the significantly smaller amplitudes.

Speech understanding with the CIS and the n-of-m strategy in the MED-EL COMBI 40+ system.

Speech tests have been performed on 6 subjects for comparing the standard 12-channel continuous interleaved sampling (CIS) strategy (CIS12), the 7-channel CIS strategy (CIS7) and the 7-of-12 strategy in the MED-EL COMBI 40+ system. An ABAB experimental design was used whereby each strategy was reversed and replicated. Speech tests were performed in quiet (vowels, consonants, monosyllables, sentences) and noise (sentences). Results showed that for vowels, CIS12 is significantly superior to CIS7, for consonants and sentences CIS12, CIS7 and 7-of-12 performed equally well, and that for monosyllables 7-of-12 is significantly superior to both CIS12 and CIS7. In addition, 7-of-12 is superior to CIS7 by almost the same amount as CIS12, but in this case the difference is not significant. Further, all strategies have been found to be equally robust in noise with respect to sentence understanding. The differences between CIS12 and 7-of-12 on the one hand and CIS7 on the other hand may be attributed to decreased spectral resolution of the latter. The fact that - in contrast to what has been reported for the SPEAK strategy - 7-of-12 is equally robust in noise as the CIS strategies is explained by the use of higher stimulation rates, wider frequency bands and a higher percentage of channels stimulated in each cycle.

On the frequency spectrum of Amplitude Modulation Following Responses.

Objective detection of Amplitude Modulation Following Responses (AMFR) is based on statistics applied after signal transformation from the time to the frequency domain by means of Discrete Fourier Transformation. In theory the frequency resolution of such transformation depends only on the analysed time window. In practise frequency resolution is also limited by the error caused by minimal difference between the clocks used for stimulus generation and Analogue/Digital-conversion. Small differences in clock frequencies may cause a spread of energy to neighbouring bins. In order to avoid this error we derived the sample clock for the A/D-conversion from the stimulator clock. By means of this technique the frequency structure of the AMFR was investigated. It is shown that if technical induced errors are excluded, the energy of the AMFR-response is limited to a very narrow frequency band. No physiologically induced disturbances of the phase locking of the AMFR to the modulation frequency could be observed. Additionally it is demonstrated that an increase of frequency resolution leads to an improved signal to noise ratio similar to the increase of averages in the time domain.

Resonant frequency pattern in multifrequency tympanograms: results in normally-hearing subjects.

This paper presents experimental data on the evaluation of middle ear resonances by multifrequency tympanometry. Multifrequency tympanograms (MFTs) of 18 normally-hearing subjects were recorded with a frequency resolution of 15 Hz. The fine structure found in the MFT patterns was compared with findings in literature. A first approach for the evaluation of this fine structure was made explaining the great variability of the main ossicular resonance frequencies described in previous publications. The consequence of the present investigation is that the concept of the main ossicular resonance has to be revised critically.

Sorted averaging--principle and application to auditory brainstem responses.

A new averaging method for evoked potentials, called sorted averaging, is presented. The method requires an ensemble of sweeps stored in memory and is based on the principle of interchangeability of individual sweeps within this ensemble. Sorted averaging is applied by sorting all sweeps according to their estimated background noise and successive averaging of this sorted ensemble, starting with low-noise sweeps. Signal-to-noise power ratio (SNR2) is estimated by calculating the inverse single point variance (Elberling & Don, 1984). This SNR2 estimate increases linearly with the number of sweeps for standard averaging and shows a clear maximum for sorted averaging. Auditory brainstem responses to click stimuli at 70 dB nHL in 20 normal hearing subjects were recorded and 4000 individual sweeps during each run were stored for analysis. In an off-line analysis, SNR2 for standard averaging with 10 microV artefact rejection, for weighted averaging and for sorted averaging were calculated. Sorted averaging was found to yield a significantly higher SNR2.

[Comparison of methods for reducing residual noise in suprathreshold early auditory evoked potential registration]. / Vergleich von Verfahren zur Reduktion der Reststörung bei überschwelligen FAEP-Registrierungen.

BACKGROUND: The level of residual noise in auditory brainstem responses (ABR) depends not only on the number of averages but also on the amplitude of background noise and on the frequency of artifacts. This paper describes the influence of digital filtering and of different methods of artifact suppression on the residual noise of ABRs. METHOD: Amplitude of background noise was estimated for 1033 ABRs recorded under suprathreshold stimulation (70 and 90 dB nHL) in 251 subjects. In 45 ABR recordings in 15 subjects, all 4000 individual sweeps were stored for off-line simulation. The power spectrum of background noise was investigated using an FFT analyzer. RESULTS: A great variability of mean noise amplitude was found both between subjects and in the recordings for each subject. Depending on the slope of the analogue 100-Hz high-pass filter, mean RMS values of background noise of 4.2 microV (6 dB/Oct.) and 2.5 microV (12 dB/Oct.), respectively, were found. Digital high pass filtering before averaging was found to increase the signal-to-noise ratio (SNR) considerably. CONCLUSIONS: Results indicate that (i) effective suppression of low-frequency noise components can only be achieved by zero phase digital filtering and (ii) if clipping of noise amplitude to 25 microV is used, optimized artifact rejection as weighted averaging or adopted artifact rejection levels have only small effect on the SNR.

Influence of electrode position on near-threshold recording of auditory evoked brainstem potentials.

Use of brainstem potentials in audiology is based on identifying a response in the near-threshold range. Wave V has turned out to be the component of the brainstem potentials that can be detected with a great deal of reliability when assessment of the threshold for the particular stimulus is desirable. As the detection of Wave I can be dispensed within audiologic diagnosis, the question arises as to whether or not a non-cephalic reference electrode compared to the common lateral position of the reference electrode on the ipsilateral mastoid produces a more stable Wave V of increased amplitude. In a group of 20 normal-hearing adults, near-threshold stimulation with clicks was conducted and the brainstem potentials recorded simultaneously with the reference electrode placed in four different locations (ipsilateral mastoid, contralateral mastoid, non-cephalic electrode, and ipsilateral earlobe). At all of the three intensities studied (10 dB nHL, 20 dB nHL and 30 dB nHL), recording with the non-cephalic reference yielded the highest amplitudes, the finding being statistically significant.

[Effect of stimulus rise time and high-pass masking on early auditory evoked potentials]. / Der Einfluss der Reizanstiegszeit und der Hochpassmaskierung auf die frühen auditorisch evozierten Potentiale.

BACKGROUND: Problems of frequency-specific objective assessment of hearing threshold by means of auditory brainstem response (ABR) have been discussed recently. While a number of workers have recommended methods of selective masking to improve the frequency specificity, others believe that frequency-specific potentials can also be obtained without masking. In this context, the effects of rise-decay time and high-pass masking on ABRs were investigated. METHOD: ABRs were recorded in normal-hearing subjects and patients with high and low frequency hearing loss by means of surface electrodes between the vertex and the ipsilateral mastoid. The frequency of the stimulus was 1 kHz, and the rise-decay time 1 ms (1-0-1) or 2 ms (2-0-2). High-pass filtered noise (cutoff frequency 1.5 kHz; filter slope 250 dB/octave) was employed for masking. Particular attention was paid to the problem of efficient masking. RESULTS: In normal-hearing subjects under the influence of high-pass masking compared to non-masked ABRs, longer mean latencies and diminished means of the amplitudes of wave V were found, with differences in the near-threshold domain being less pronounced. Similar results were observed in patients with high frequency hearing loss. In patients with low frequency hearing loss, the influence of high-pass masking was especially marked distinctly near to threshold. Furthermore, latency and amplitude differences of wave V of the 1-0-1 and the 2-0-2 stimuli were determined from the ABRs obtained with and without high-pass masking. The differences between the latency differences of both stimuli in the suprathreshold range (70 dB nHL) only were statistically significant. CONCLUSIONS: The results are suggestive of an inadequate frequency specificity of unmasked stimuli in the suprathreshold range. Evaluation of the latencies revealed for both rise-decay times a similar frequency specificity near the threshold and a higher frequency specificity of the longer stimulus in the suprathreshold range.

[An optimal electrode position for recording auditory evoked brain stem potentials within the scope of pediatric audiology]. / Eine optimale Elektrodenposition für die Ableitung auditorisch evozierter Hirnstammpotentiale im Rahmen der Pädaudiologie.

BACKGROUND: Estimation of hearing threshold in children is based on reliable identification of a response to a stimulus in the near-threshold range. It is well known that only wave V can be detected in brainstem potentials evoked by near-threshold stimuli. So the question arises as to whether or not a noncephalic reference electrode compared to the common lateral postition of the reference electrode on the ipsilateral mastoid produces a more stable wave V of increased amplitude. METHOD: Thirty-three normal hearing children in three age groups (< 6 years, 6-10 years, > 10 years) were investigated. For a near-threshold stimulation with 100-microsecond-clicks (10, 20, 30 dB nHL), bioactivity was simultaneously recorded with the reference electrode in four different locations (ipsilateral mastoid, contralateral mastoid, ipsilateral earlobe, and noncephalic electrode). RESULTS: The noncephalic reference produced the highest absolute and scaled amplitudes. This finding was statistically significant. For all investigated intensities, recording with the noncephalic reference electrode yielded the highest number of reliable detectable potentials. Evaluation of the residual noise in the four recording locations revealed a significantly increased noise level for the noncephalic electrode at the nape of the neck. CONCLUSIONS: Even if the residual noise is increased, the use of noncephalic reference results in a more reliable detection of wave V compared to the conventional locations of the reference electrode.

Auditory event-related potentials in post- and prelingually deaf cochlear implant recipients.

The development of central auditory functions in cochlear implant (CI) patients was studied over six months of rehabilitation. Examinations were performed beginning with the first week after processor calibration, and in monthly follow-up sessions thereafter. The subjects were given a simple auditory perception task (detection of a 400 Hz and a 1450 Hz tone), as well as an oddball-paradigm (detection of one of the tones as a rare deviant). Auditory evoked potentials, reaction time and errors were recorded. Results from five patients, two postlingually deaf and three prelingually deaf CI recipients are shown. Generally, in the auditory evoked potentials of patients a shortening of N100 latency towards those of subjects with normal hearing was seen from month to month. However, in the prelingually deaf patients this effect was weaker and more variable over time. Three CI recipients showed a P300 component in the oddball-paradigm in correlation with their performance. Two prelingually deaf patients failed to show a P300 in the oddball-paradigm. For both components, the N100 and the P300 we found a larger spreading over the skull in the patients compared to a normal hearing person. The results show that from the very first days after initial processor fitting prelingually and postlingually deaf CI recipients may show cortical correlates of stimulus processing and discrimination. For some components of the auditory evoked potentials an initial temporal change but a maintained larger spreading over the skull was seen.

[Contralateral modification of transitory evoked otoacoustic emissions]. / Kontralaterale Beeinflussung transitorisch evozierter otoakustischer Emissionen.

BACKGROUND: In recent publications the influence of contralateral white noise on transient evoked otoacoustic emissions (TEOAE) is discussed with regard on contributions of the efferent auditory system. METHODS: In the present study the effects have been investigated with regards to middle-ear muscles, efferents and cross hearing. TEOAE to monaural 40-80 dB SPL clicks were recorded in normal-hearing adults under simultaneous presentation of 20-60 dB SPL broadband noise to the contralateral ear. Control runs were performed before, during a short break of, and after contralateral stimulation. The control run before contralateral stimulation was used as a reference. RESULTS: Decrease in TEOAE, and increase in accompanying noise floor, were found to follow the contralateral stimulation. In particular a 1-3 dB decrease was found for contralateral noise levels of 40 and 60 dB SPL, even though the readings at 60 dB only were statistically significant (paired-samples t test, p = 0.05). For both TEOAE and noise floor no systematic dependence on click intensity was seen. The control runs during temporary break and after contralateral noise revealed an increase in both TEOAE and noise floor. As a rule, the TEOAE adapted to the reference within 2-3 min following the cessation of contralateral stimulation, whereas the increased noise floor level was still noted after 10 min. CONCLUSIONS: Traditionally, suppressing effects of contralateral stimulation on TEOAE have been attributed to cochlear efferents (CEs). Occasionally, the middle-ear muscle and cross hearing involvement have been considered as well. Substantially, the present results and findings of other workers are inconsistent with the basic knowledge of CE functioning: (I) The decrease in TEOAE under contralateral stimulation is in conflict with an increase in cochlear microphonics and summating potentials observed during activation of CEs: (II) contralateral suppression of TEOAE exhibited no significant dependence on the test-stimulus level while the CEs are known to be efficient in the range of the low signal intensities only, and (III) acoustic activation of the CEs can hardly be expected to reach levels sufficient to influence the TEOAE mechanism. The present findings, i.e. decrease in TEOAE and increase in noise floor level, can more reasonably be explained as being mainly attributable to activation of the middle-ear muscles.