On the Cost of Introducing Speech-Like Properties to a Stimulus for Auditory Steady-State Response Measurements.

Validating hearing-aid fittings in prelingual infants is challenging because typical measures (aided audiometry, etc.) are impossible with infants. One objective alternative uses an aided auditory steady-state response (ASSR) measurement. To make an appropriate measurement, the hearing aid's signal-processing features must be activated (or deactivated) as if the ASSR stimulus was real speech. Rather than manipulating the hearing-aid settings to achieve this, an ASSR stimulus with speech-like properties was developed. This promotes clinical simplicity and face validity of the validation. The stimulus consists of narrow-band CE-Chirps®, modified to mimic the International Speech Test Signal (ISTS). This study examines the cost of introducing the speech-like features into the ASSR stimulus. Thus, 90 to 100 Hz ASSRs were recorded to the ISTS-modified stimulus as well as an equivalent stimulus without the ISTS modification, presented through insert phones to 10 young normal-hearing subjects. Noise-corrected ASSR magnitudes and clinically relevant detection times were estimated and analyzed with mixed-model analyses of variance. As a supplement, the observed changes to the ASSR magnitudes were compared with an objective characterization of the stimuli based on modulation power. The main findings were a reduction in ASSR magnitude of 4 dB and an increase in detection time by a factor of 1.5 for the ISTS-modified stimulus compared with the standard. Detection rates were unaffected given sufficient recording time. For clinical use of the hearing-aid validation procedure, the key metric is the detection time. While this varied considerably across subjects, the observed 50% mean increase corresponds to less than 1 min of additional recording time.

Accuracy of averaged auditory brainstem response amplitude and latency estimates.

OBJECTIVE: The aims were to 1) establish which of the four algorithms for estimating residual noise level and signal-to-noise ratio (SNR) in auditory brainstem responses (ABRs) perform better in terms of post-average wave-V peak latency and amplitude errors and 2) determine whether SNR or noise floor is a better stop criterion where the outcome measure is peak latency or amplitude. DESIGN: The performance of the algorithms was evaluated by numerical simulations using an ABR template combined with electroencephalographic (EEG) recordings obtained without sound stimulus. The suitability of a fixed SNR versus a fixed noise floor stop criterion was assessed when variations in the wave-V waveform shape reflecting inter-subject variation was introduced. STUDY SAMPLE: Over 100 hours of raw EEG noise was recorded from 17 adult subjects, under different conditions (e.g. sleep or movement). RESULTS: ABR feature accuracy was similar for the four algorithms. However, it was shown that a fixed noise floor leads to higher ABR wave-V amplitude accuracy; conversely, a fixed SNR yields higher wave-V latency accuracy. CONCLUSION: Similar performance suggests the use of the less computationally complex algorithms. Different stop criteria are recommended if the ABR peak latency or the amplitude is the outcome measure of interest.

Calibration of brief stimuli for the recording of evoked responses from the human auditory pathway.

The relationship between the calibration RETSPL-values (reference equivalent threshold sound pressure level) in dB p-p.e.SPL and the corresponding sound pressure levels in dB SPL for brief stimuli is formulated mathematically. The formula is applied on ten brief stimuli consisting of a click, four tone-bursts, a chirp, and four octave-band chirps presented at a stimulus rate of 20 stimuli per second, and using the average acoustical parameter-values from a sample of 20 ER-3A insert earphones in the occluded-ear simulator. The reference calibration values in dB SPL for the ten stimuli are then established. These theoretical values are verified by direct measurements using two different sound-level-meters. It is concluded that the calibration values in dB SPL can be applied in the practical calibration of common brief stimuli. Calibration with these reference values involves only a sound-level meter, and the need for including an oscilloscope in the calibration setup is therefore eliminated.

Auditory brainstem responses to level-specific chirps in normal-hearing adults.

BACKGROUND: Upward chirps are often designed to compensate for the cochlear traveling wave delay which is regarded as independent of stimulation level. A chirp based on a traveling wave model is therefore referred to as a level-independent chirp. Another compensation strategy, for instance based on frequency-specific auditory brainstem response (ABR) latencies, results in a chirp that changes with stimulation level and is therefore referred to as a level-dependent chirp. One such strategy, the direct approach, results in a chirp family that is called the level-specific chirp. The level dependence is in agreement with the findings that the chirp, which generates the largest ABR in normal-hearing adults, has a duration (sweeping rate) that changes with stimulus level. A direct comparison of ABRs to a fixed chirp and to a level-specific chirp has not been performed at higher levels of stimulation where the differences are thought to have the greatest effect on the ABR characteristics from normal-hearing adults. PURPOSE: To make a direct comparison of the ABRs to two different chirp stimuli-a level-specific chirp (LS-Chirp) and a level-independent chirp (CE-Chirp)-and to evaluate the hypothesis that at higher levels of stimulation the LS-Chirp generates significantly higher response amplitudes, and produces higher resolution of the different peaks in the ABR than the CE-Chirp. RESEARCH DESIGN: ABRs are recorded in 10 normal-hearing adults (20 ears) in response to three stimuli at four presentation levels using ER-3A insert earphones. The three stimuli are (1) a level-specific chirp (LS-Chirp), (2) a level-independent chirp (CE-Chirp), and (3) a standard 100-µs click as a reference. The recorded ABRs are evaluated by the peak to trough amplitude (wave V), the peak latency (wave V), the frequency of appearance of wave I, III, and V, and the Grand Average waveforms. Amplitude and latency differences are evaluated statistically by the Wilcoxon matched-pair signed rank test. RESULTS: At higher levels (80 dB nHL), the amplitude and waveform resolution of the ABR to the LS-Chirp are significantly higher than to the CE-Chirp. At lower levels (20, 40, and 60 dB nHL), no significant differences are found between the amplitudes of the ABR to the two stimuli, but at 60 dB nHL the waveform resolution is better for the LS-Chirp than for the CE-Chirp. For all levels, the amplitude of the ABRs to the two chirps are significantly larger than to the Click, except at 80 dB nHL where the ABR to the CE-Chirp gets distorted and low in amplitude. The differences between the ABR latencies to the three stimuli are large at higher levels, but small at lower levels. At higher levels, the LS-Chirp and the Click generate similar resolutions of the main ABR peaks, but the ABRs to the LS-Chirp are significantly larger than to the Click. CONCLUSIONS: The study confirms the experimental hypothesis that at higher levels of stimulation the LS-Chirp generates significantly higher response amplitudes than both the CE-Chirp and the Click. It also generates a much better response resolution than the CE-Chirp, but the same response resolution as the Click.

Reference hearing threshold levels for chirp signals delivered by an ER-3A insert earphone.

OBJECTIVE: To establish reference hearing threshold levels for chirps and frequency-specific chirps. DESIGN: Hearing thresholds were determined monaurally for broad-band chirps and octave-band chirps using the Etymotic Research, ER-3A insert earphone. The chirps were presented using two repetition rates, 20 and 90 stimuli/s, and with alternating polarity in blocks of one second duration. The test procedure and test conditions were in accordance with the recommendations given in ISO 389-9 (2009) . The ascending method ( ISO 8253-1, 2010 ) was applied using a step size of 5 dB. The chirps were played back from a Tucker Davies Technologies System II, and a Matlab program controlled the test setup. The results are specified in dB peak-to-peak equivalent threshold sound pressure levels (dB peETSPL). STUDY SAMPLE: The test group consisted of 25 otologically-normal young adults (age 18-25 years). RESULTS: The results are in good agreement with the results from another investigation of hearing thresholds using the same chirp stimuli, and the values for the octave-band chirps are in line with the standardized reference values for corresponding tone bursts ( ISO 389-6, 2007 ). CONCLUSIONS: The results of the present investigation are relevant for the international standard on short duration signals, ISO 389-6 (2007) .

Auditory brainstem responses to chirps delivered by an insert earphone with equalized frequency response.

Recently it has been demonstrated that auditory brainstem responses, ABRs, to chirps are larger with the ER-2 than with the ER-3A insert earphone due to differences between the corresponding amplitude-frequency responses. Therefore a modified chirp, which equalizes the amplitude-frequency response of the ER-3A, is constructed and subsequently compared to the unmodified chirp. ABRs are recorded from 20 normal-hearing subjects in response to the two chirps delivered by the ER-3A earphone at a wide range of levels. The results confirm that the modified chirp generates significantly larger ABRs than the unmodified chirp at levels below 60 dB nHL.

Modeling auditory evoked brainstem responses to transient stimuli.

A quantitative model is presented that describes the formation of auditory brainstem responses (ABRs) to tone pulses, clicks, and rising chirps as a function of stimulation level. The model computes the convolution of the instantaneous discharge rates using the "humanized" nonlinear auditory-nerve model of Zilany and Bruce [J. Acoust. Soc. Am. 122, 402-417 (2007)] and an empirically derived unitary response function which is assumed to reflect contributions from different cell populations within the auditory brainstem, recorded at a given pair of electrodes on the scalp. It is shown that the model accounts for the decrease of tone-pulse evoked wave-V latency with frequency but underestimates the level dependency of the tone-pulse as well as click-evoked latency values. Furthermore, the model correctly predicts the nonlinear wave-V amplitude behavior in response to the chirp stimulation both as a function of chirp sweeping rate and level. Overall, the results support the hypothesis that the pattern of ABR generation is strongly affected by the nonlinear and dispersive processes in the cochlea.

Auditory brainstem responses to chirps delivered by different insert earphones.

The frequency response and sensitivity of the ER-3A and ER-2 insert earphones are measured in the occluded-ear simulator using three ear canal extensions. Compared to the other two extensions, the DB 0370 (Brüel & Kjær), which is recommended by the international standards, introduces a significant resonance peak around 4500 Hz. The ER-3A has an amplitude response like a band-pass filter (1400 Hz, 6 dB/octave -4000 Hz, -36 dB/octave), and a group delay with "ripples" of up to ±0.5 ms, while the ER-2 has an amplitude response, and a group delay which are flat and smooth up to above 10000 Hz. Both earphones are used to record auditory brainstem responses, ABRs, from 22 normal-hearing ears in response to two chirps and a click at levels from 20 to 80 dB nHL. While the click-ABRs are slightly larger for ER-2 than for ER-3A, the chirp-ABRs are much larger for ER-2 than for ER-3A at levels below 60 dB nHL. With a simulated amplitude response of the ER-3A and the smooth group delay of the ER-2 it is shown that the increased chirp-ABR amplitude with the ER-2 is caused by its broader amplitude response and not by its smoother group delay.

A direct approach for the design of chirp stimuli used for the recording of auditory brainstem responses.

A recent study evaluates auditory brainstem responses (ABRs) evoked by chirps of different durations (sweeping rates) [Elberling et al. (2010). J. Acoust. Soc. Am. 128, 215-223]. The study demonstrates that shorter chirps are most efficient at higher levels of stimulation whereas longer chirps are most efficient at lower levels. Mechanisms other than the traveling wave delay, in particular, upward spread of excitation and changes in cochlear-neural delay with level, are suggested to be responsible for these findings. As a consequence, delay models based on estimates of the traveling wave delay are insufficient for the design of chirp stimuli, and another delay model based on a direct approach is therefore proposed. The direct approach uses ABR-latencies from normal-hearing subjects in response to octave-band chirps over a wide range of levels. The octave-band chirps are constructed by decomposing a broad-band chirp, and constitute a subset of the chirp. The delay compensations of the proposed model are similar to those found in the previous experimental study, which thus verifies the results of the proposed model.

Auditory brain stem responses evoked by different chirps based on different delay models.

BACKGROUND: A cochlear delay model has previously been proposed for the construction of a chirp stimulus in order to compensate for the temporal dispersion in the auditory periphery. The large intersubject variability in the model data suggests that a chirp constructed from the average model data will not be able to compensate equally well for the temporal dispersion in all normal-hearing subjects. For the recording of the auditory brain stem response (ABR), it has been suggested that the most efficient chirp for generating the largest response amplitude changes in duration with level, indicating that the delay model exhibits a latency change with frequency, which becomes larger at lower levels. PURPOSE: To investigate in normal-hearing subjects how the ABR varies in response to five different chirps and to study how the efficiency of each chirp changes with stimulus level. RESEARCH DESIGN: A click and five chirps of different durations and constructed from the proposed delay model were designed with identical amplitude spectra. The six stimuli were used to record the ABR from 50 normal-hearing test subjects using a quasi-simultaneous stimulation technique at 50 and 30 dB nHL. The ABR recordings were evaluated by the peak-to-trough amplitude and the peak latency. RESULTS: For the test group the following level effect was demonstrated: at 50 dB nHL the largest response amplitude was provided by a shorter chirp, whereas at 30 dB nHL the largest response amplitude was provided by a longer chirp. There is, however, large variability as to which of the five chirps generated the largest response in each individual subject, but at the two levels of stimulation, the best chirps were significantly correlated across the test group. All five chirps generated significantly larger ABRs than the click, but at 30 dB nHL the gain in response amplitude by using the chirps instead of the click was larger than at 50 dB nHL. CONCLUSIONS: A chirp that evokes the largest broadband ABRs in normal-hearing subjects changes in duration with level-that is, being relatively short at higher levels (50 dB nHL) and relatively long at lower levels and near the threshold. However, the changes in amplitude in response to chirps of different durations are not very large, and it is therefore uncertain whether the outcome from using such chirps actually would outweigh the instrumental complexity of implementation. It appears that the largest advantage of using the chirp over the click is found at the lower levels of stimulation.

Evaluating auditory brainstem responses to different chirp stimuli at three levels of stimulation.

Auditory brainstem responses (ABRs) are recorded in ten normal-hearing adults (20 ears) in response to a standard 100 micros click and five chirps having different durations (sweeping rates). The chirps are constructed from five versions of a power function model of the cochlear-neural delay that is based on derived-band ABR latencies from N=81 normal-hearing adults [Elberling, C., and Don, M. (2008). J. Acoust. Soc. Am. 124, 3022-3037]. The click and the chirps have identical amplitude spectra and, in general, for each of the three stimulus levels 60, 40, and 20 dB nHL, the ABRs to the chirps are significantly larger than the ABRs to the click. However, the shorter chirps are the most efficient at higher levels of stimulation whereas the longer chirps are the most efficient at lower levels. It is suggested that two different mechanisms are responsible for these observed changes with stimulus level--(1) upward spread of excitation at higher levels, and (2) an increased change of the cochlear-neural delay with frequency at lower levels.

Input and output compensation for the cochlear traveling wave delay in wide-band ABR recordings: implications for small acoustic tumor detection.

BACKGROUND: The Stacked ABR (auditory brainstem response) attempts at the output of the auditory periphery to compensate for the temporal dispersion of neural activation caused by the cochlear traveling wave in response to click stimulation. Compensation can also be made at the input by using a chirp stimulus. It has been demonstrated that the Stacked ABR is sensitive to small tumors that are often missed by standard ABR latency measures. PURPOSE: Because a chirp stimulus requires only a single data acquisition run whereas the Stacked ABR requires six, we try to evaluate some indirect evidence justifying the use of a chirp for small tumor detection. RESEARCH DESIGN: We compared the sensitivity and specificity of different Stacked ABRs formed by aligning the derived-band ABRs according to (1) the individual's peak latencies, (2) the group mean latencies, and (3) the modeled latencies used to develop a chirp. RESULTS: For tumor detection with a chosen sensitivity of 95%, a relatively high specificity of 85% may be achieved with a chirp. CONCLUSION: It appears worthwhile to explore the actual use of a chirp because significantly shorter test and analysis times might be possible.

Auditory brainstem responses to a chirp stimulus designed from derived-band latencies in normal-hearing subjects.

In an attempt to compensate for the temporal dispersion in the human cochlea, a chirp has previously been designed from estimates of the cochlear delay based on derived-band auditory brain-stem response (ABR) latencies [Elberling et al. (2007). "Auditory steady-state responses to chirp stimuli based on cochlear traveling wave delay," J. Acoust. Soc. Am. 122, 2772-2785]. To evaluate intersubject variability and level effects of such delay estimates, a large dataset is analyzed from 81 normal-hearing adults (fixed click level) and from a subset thereof (different click levels). At a fixed click level, the latency difference between 5700 and 710 Hz ranges from about 2.0 to 5.0 ms, but over a range of 60 dB, the mean relative delay is almost constant. Modeling experiments demonstrate that the derived-band latencies depend on the cochlear filter buildup time and on the unit response waveform. Because these quantities are partly unknown, the relationship between the derived-band latencies and the basilar membrane group delay cannot be specified. A chirp based on the above delay estimates is used to record ABRs in ten normal-hearing adults (20 ears). For levels below 60 dB nHL, the gain in amplitude of chirp-ABRs to click-ABRs approaches 2, and the effectiveness of chirp-ABRs compares favorably to Stacked-ABRs obtained under similar conditions.

Auditory steady-state responses to chirp stimuli based on cochlear traveling wave delay.

This study investigates the use of chirp stimuli to compensate for the cochlear traveling wave delay. The temporal dispersion in the cochlea is given by the traveling time, which in this study is estimated from latency-frequency functions obtained from (1) a cochlear model, (2) tone-burst auditory brain stem response (ABR) latencies, (3) and narrow-band ABR latencies. These latency-frequency functions are assumed to reflect the group delay of a linear system that modifies the phase spectrum of the applied stimulus. On the basis of this assumption, three chirps are constructed and evaluated in 49 normal-hearing subjects. The auditory steady-state responses to these chirps and to a click stimulus are compared at two levels of stimulation (30 and 50 dB nHL) and a rate of 90s. The chirps give shorter detection time and higher signal-to-noise ratio than the click. The shorter detection time obtained by the chirps is equivalent to an increase in stimulus level of 20 dB or more. The results indicate that a chirp is a more efficient stimulus than a click for the recording of early auditory evoked responses in normal-hearing adults using transient sounds at a high rate of stimulation.

New clicklike stimuli for hearing testing.

The click stimulus generally used for newborn hearing screening generates a traveling wave along the basilar membrane, which excites each of the frequency bands in the cochlea, one after another. Due to the lack in synchronization of the excitations, the summated response amplitude is low. A repetitive click-like stimulus can be set up in the frequency domain by adding a high number of cosines, the frequency intervals of which comply with the desired stimulus repetition rate. Straight-forward compensation of the cochlear traveling wave delay is possible with a stimulus of this type. As a result, better synchronization of the neural excitation can be obtained so that higher response amplitudes can be expected. The additional introduction of a frequency offset enables the use of a q-sample test for response detection. The results of investigations carried out on a large group of normal-hearing test subjects have confirmed the enhanced efficiency of this stimulus design. The new stimuli lead to significantly higher response SNRs and thus higher detection rates and shorter detection times. Using band-limited stimuli designed in the same manner, a "frequency-specific" hearing screening seems to be possible.

New efficient stimuli for evoking frequency-specific auditory steady-state responses.

ASSR is a promising tool for the objective frequency-specific assessment of hearing thresholds in children. The stimulus generally used for ASSR recording (single amplitude-modulated carrier) only activates a small area on the basilar membrane. Therefore, the response amplitude is low. A stimulus with a broader frequency spectrum can be composed by adding several cosines whose frequency intervals comply with the desired stimulus repetition rate. Compensation of the travelling wave delay on the basilar membrane is possible with a stimulus of this type. Through this, a better synchronization of the neural response can be obtained and, as a result, higher response amplitudes can be expected, particularly for low-frequency stimuli. The additional introduction of a frequency offset enables the use of a q-sample test for the response detection, especially important at 500 Hz. The results of investigations carried out on a large group of normally hearing test subjects have confirmed the efficiency of this stimulus design. The new stimuli lead to significantly improved ASSRs with higher SNRs and thus higher detection rates and shorter detection times.

Linear and nonlinear hearing aid fittings--1. Patterns of benefit.

We evaluated the benefits of fast-acting WDRC, slow-acting AVC, and linear reference fittings for speech intelligibility and reported disability, in a within-subject within-device masked crossover design on 50 listeners with SNHL. Five hearing aid fittings were implemented having two compression channels and seven frequency bands. Each listener sequentially experienced each fitting for a 10-week period. Outcome measures included speech intelligibility under diverse conditions and self-reported disability. At a group level, each nonlinear fitting was superior to the linear references for benefits in listening comfort, listener satisfaction, reported intelligibility and speech intelligibility. Slow-acting AVC outperformed the fast-acting WDRC fittings for listening comfort, while for reported and measured speech intelligibility the converse was true. For listener satisfaction there were no group differences between the nonlinear fittings. Analysis in terms of fittings for individual listeners revealed subsets with definite divergences from the group data and hence a need for candidature criteria. There are systematic differences between the benefits of nonlinear and linear fittings, and also within nonlinear fittings with fast versus slow time constants. The patterns of benefit and individual optima depend on the domain of outcome being assessed.

Linear and nonlinear hearing aid fittings--2. Patterns of candidature.

We studied candidature for linear, slow-acting AVC hearing aids, and fast-acting WDRC hearing aids in a within-subject within-device crossover design of 50 listeners with SNHL. Candidature dimensions include HTLs, ULLs, spectro-temporal and masking abnormalities, cognitive capacity, and self-reports and acoustic measures of auditory ecology. Better performance with linear fittings is associated with flatter audiograms, wider dynamic range, and smaller differences in dynamic range between low and high frequencies, and also with more restricted auditory lifestyles. Better performance with all nonlinear fittings is associated with more sloping audiograms, more restricted dynamic ranges, greater differences in dynamic range between low and high frequencies, and more varied auditory lifestyles. Differential performance between WDRC and AVC fittings is associated with patterns of variation in auditory ecology (rapid versus slow changes) and cognitive (high versus low) capacity. Differential performance between WDRC in two channels, and a hybrid with WDRC in a low-frequency and AVC in a high-frequency channel is associated with psychoacoustic tests of cochlear function (high susceptibility to spectral and temporal smearing, and high susceptibility to upward spread of masking respectively). Patterns of candidature include measures beyond auditory function in the domains of cognitive capacity and auditory ecology.

Objective detection of auditory steady-state responses: comparison of one-sample and q-sample tests.

Auditory steady-state responses (ASSR) are expected to be useful for the objective, frequency-specific assessment of hearing thresholds in small children. To detect ASSR close to the hearing threshold, a powerful statistical test has to be applied. At present, so-called one-sample tests are used. These tests only evaluate the phase, or the phase and amplitude, of the first harmonic, that is, the fundamental frequency. It is shown that higher harmonics with significant amplitudes are also contained in the ASSR spectrum. For this reason, statistical tests that only consider the first harmonic ignore a significant portion of the available information. The use of a q-sample test, which, in addition to the fundamental frequency, also includes higher harmonics in the detection leads to a better detection performance. The evaluation of test performance uses both detection rate and detection time.

Automated auditory response detection: statistical problems with repeated testing.

Sequential application of a statistical test is usually applied in an automated auditory response detection algorithm. The sequential test strategy is very time-efficient but increases the probability of a false rejection of the null-hypothesis. For this reason, it is necessary to correct the critical test value. However, the well-known Bonferroni correction leads to an over-correction when dealing with dependent or partly dependent data. The objective of the study reported here was to develop a method to determine the critical test value for the sequential testing of dependent data. Extensive Monte Carlo simulations were used to develop this method. The simulation results were reviewed and the benefit of the suggested method, in comparison to the Bonferroni correction, was shown using a large sample of real amplitude modulation following response data. The detection rate determined for these data and the ROC curve demonstrate the advantage of using the method suggested here.