Interaural stacked auditory brainstem response measures for detecting small unilateral acoustic tumors.

The Stacked auditory brainstem response (SABR) was developed and investigated as a screening tool for small (≤1 cm) unilateral acoustic tumors (vestibular schwannomas) that were missed by standard clinical auditory brainstem response (ABR) measures [Don et al.: Am J Otol 1997;18:608-621; Audiol Neurotol 2005;10:274-290]. While the SABR measure provided much greater sensitivity than the standard ABR measures for small tumor detection, we believed that the large intersubject variability of the SABR measure compromised both the sensitivity and specificity of the measure. However, as we demonstrate in this paper, the variability between ears of a given individual is small. Thus, we introduced an interaural SABR (ISABR) amplitude difference measure to improve the sensitivity and specificity of the SABR amplitude measure to detect small unilateral acoustic tumors. Its main advantages are two-fold. First, it is somewhat immune to variables that affect the absolute SABR amplitudes because it is a relative measure. Second, it is better at assessing tumor patients with very large and non-tumor patients with very small absolute SABR amplitudes. We believe that the ISABR is a useful addition to ABR measures aimed at detecting the presence of unilateral acoustic tumors.

An alternative diagnostic test for active Ménière's disease and cochlear hydrops using high-pass noise masked responses: the complex amplitude ratio.

We [Don et al.: Otol Neurotol 2005;26:711-722] previously demonstrated that patients diagnosed with an active case of Ménière's disease could be distinguished from non-Ménière's normal-hearing subjects by a special auditory brainstem response method involving clicks and ipsilateral high-pass masking pink noise. Specifically, auditory brainstem responses to clicks presented alone and clicks with masking noise high-pass filtered at 8, 4, 2, 1 and 0.5 kHz were recorded. It was shown that the level of masking noise sufficient to progressively mask the response to clicks in non-Ménière's normal-hearing subjects was insufficient to appropriately mask the responses in Ménière's disease subjects, resulting in an obvious undermasked component. A relative latency measure of wave V or the undermasked component in the response to clicks with 0.5 kHz high-pass masking noise and wave V in the response to clicks presented alone clearly distinguished these two groups on an individual level, thus making it a valuable clinical tool. However, determining the peak latency of wave V or the undermasked component can be difficult in some cases. In anticipation of this difficulty, we investigated and present in this paper several amplitude measures that may help in the evaluation of these cases. One amplitude measure, the 'complex amplitude ratio', appears to be a good alternative when the latency measure of the undermasked component is difficult to determine.

A diagnostic test for Ménière's Disease and Cochlear Hydrops: impaired high-pass noise masking of auditory brainstem responses.

HYPOTHESIS: Endolymphatic hydrops in patients diagnosed with Ménière's disease causes changes in the response properties of the basilar membrane that lead to impaired high-pass noise masking of auditory brainstem responses to clicks. BACKGROUND: Ménière's disease is defined as the idiopathic syndrome of endolymphatic (cochlear) hydrops, which is an abnormal increase in the volume of cochlear fluid (endolymph) in the inner ear. Accurate detection and diagnosis are important but difficult because of the lack of sufficiently sensitive tests. METHODS: Two populations were compared: (1) 38 non-Ménière's normal-hearing subjects; and (2) 23 patients who, at the time of testing, continued to have at least three of the four hallmark symptoms (i.e., tinnitus, vertigo, fluctuating hearing loss, and fullness) used in the diagnosis of Ménière's disease. Auditory brainstem responses to clicks presented ipsilaterally with masking noise that was high-pass filtered at various frequencies were recorded. RESULTS: In the Ménière's patients, the masking noise is insufficient such that an undermasked Wave V is still present at a latency similar to that of Wave V in the response to the clicks alone. In the control non-Ménière's normal-hearing subjects, this undermasked component was either absent or significantly delayed because of the masking noise. The difference in the delays between these populations is such that the distributions do not overlap, resulting in 100% sensitivity and 100% specificity. CONCLUSION: This test is able to distinguish objectively active Ménière's disease in individuals and may show promise for tracking changes in the severity of the disease caused by progression or treatment.

The stacked ABR: a sensitive and specific screening tool for detecting small acoustic tumors.

The failure of standard ABR measures to detect small (< or =1 cm) acoustic tumors has led to the use of enhanced magnetic resonance imaging (MRI) as the standard to screen for small tumors. This study investigates the suitability of the stacked ABR as a sensitive screening alternative to MRI for small acoustic tumors (SATs). The objective of the study was to determine the sensitivity and specificity of the stacked ABR technique for detecting SATs. A total of 54 patients with acoustic tumors identified by MRI that were either < or =1 cm in size or undetected by standard ABR methods, irrespective of size, were studied. A control population of 78 nontumor normal-hearing subjects was also tested. For comparison, two standard ABR measures (IT5 and I-V delay) were also analyzed. The stacked ABR demonstrated 95% sensitivity and 88% specificity; 100% sensitivity was obtained at 50% specificity. Standard ABR measures were much poorer in detecting these tumors. In conclusion, the stacked ABR can be used as a sensitive, widely-available, cost-effective, and comfortable tool for screening SATs.

Differential ear effects of profound unilateral deafness on the adult human central auditory system.

This study investigates the effects of profound acquired unilateral deafness on the adult human central auditory system by analyzing long-latency auditory evoked potentials (AEPs) with dipole source modeling methods. AEPs, elicited by clicks presented to the intact ear in 19 adult subjects with profound unilateral deafness and monaurally to each ear in eight adult normal-hearing controls, were recorded with a 31-channel system. The responses in the 70-210 ms time window, encompassing the N1b/P2 and Ta/Tb components of the AEPs, were modeled by a vertically and a laterally oriented dipole source in each hemisphere. Peak latencies and amplitudes of the major components of the dipole waveforms were measured in the hemispheres ipsilateral and contralateral to the stimulated ear. The normal-hearing subjects showed significant ipsilateral-contralateral latency and amplitude differences, with contralateral source activities that were typically larger and peaked earlier than the ipsilateral activities. In addition, the ipsilateral-contralateral amplitude differences from monaural presentation were similar for left and for right ear stimulation. For unilaterally deaf subjects, the previously reported reduction in ipsilateral-contralateral amplitude differences based on scalp waveforms was also observed in the dipole source waveforms. However, analysis of the source dipole activity demonstrated that the reduced inter-hemispheric amplitude differences were ear dependent. Specifically, these changes were found only in those subjects affected by profound left ear unilateral deafness.

Maturation of human central auditory system activity: the T-complex.

OBJECTIVE: The purpose of this study was to evaluate and describe the maturation of a set of auditory evoked potentials (AEPs) described as the T-complex from a large group of children, adolescents, and young adults who ranged in age from 5 to 20 years of age. METHODS: The AEPs evoked by brief trains of clicks presented to the left ear were measured at 30 scalp-electrode locations. Analyses focused on age-related latency and amplitude changes in the T-complex recorded at the temporal electrode sites T3 and T5 over the left hemisphere and T4 and T6 over the right hemisphere. The maturation of the T-complex components Na, Ta, and Tb was contrasted with those of the obligatory AEPs P1, N1b, and P2 measured at electrodes C3 and C4. RESULTS: T-complex activity was present in the grand average AEPs of all 14 age groups spanning ages 5-20 years. T-complex components recorded at electrodes T3 and T4 differed in both morphology and maturation rate from those recorded at T5 and T6. In contrast to the prolonged maturation of AEP latency measured at electrodes T5 and T6, the T-complex components measured at electrodes T3 and T4 did not show a significant overall change in peak latency as a function of age. Consistent amplitude and latency correlations were found between the obligatory AEP components P1, N1b and P2 recorded at C3 and C4 and the T-complex components measured at T5 and T6, but not T3 and T4. CONCLUSIONS: Distinct patterns of AEP maturation were measured at electrode sites commonly used to record the T-complex. At scalp electrodes located over more posterior temporal areas (T5 and T6), the AEPs were characterized by a prolonged pattern of maturation very similar to that measured at the central electrodes C3 and C4. These findings and others reported in this paper provide strong evidence that the AEPs recorded at electrodes T5 and T6 are not T-complex peaks. In contrast, the AEPs measured at electrodes T3 and T4 over more anterior temporal scalp areas appear largely independent of activity measured at the central electrode locations. The T-complex peaks Ta and Tb measured at these scalp locations mature early, with no overall significant age-related changes in peak latencies. SIGNIFICANCE: The T-complex is recorded from the temporal electrodes T3 and T4 represents activity of secondary auditory cortex better than, and independent from, midline potentials. Its robust presence in 5-8 year olds supports its potential usefulness in assessing language impairment.

Maturation of human central auditory system activity: separating auditory evoked potentials by dipole source modeling.

OBJECTIVES: Previous studies have shown that observed patterns of auditory evoked potential (AEP) maturation depend on the scalp location of the recording electrodes. Dipole source modeling incorporates the AEP information recorded at all electrode locations. This should provide a more robust description of auditory system maturation based on age-related changes in AEPs. Thus, the purpose of this study was to evaluate central auditory system maturation based dipole modeling of multi-electrode long-latency AEPs recordings. METHODS: AEPs were recorded at 30 scalp-electrode locations from 118 subjects between 5 and 20 years of age. Regional dipole source analysis, using symmetrically located sources, was used to generate a spatio-temporal source model of age-related changes in AEP latency and magnitude. RESULTS: The regional dipole source model separated the AEPs into distinct groups depending on the orientation of the component dipoles. The sagittally oriented dipole sources contained two AEP peaks, comparable in latency to Pa and Pb of the middle latency response (MLR). Although some magnitude changes were noted, latencies of Pa and Pb showed no evidence of age-related change. The tangentially oriented sources contained activity comparable to P1, N1b, and P2. There were various age-related changes in the latency and magnitude of the AEPs represented in the tangential sources. The radially oriented sources contained activity comparable to the T-complex, including Ta, and Tb, that showed only small latency changes with age. In addition, a long-latency component labeled TP200 was observed. CONCLUSIONS: It is possible to distinguish 3 maturation groups: one group reaching maturity at age 6 and comprising the MLR components Pa and Pb, P2, and the T-complex. A second group that was relatively fast to mature (50%/year) was represented by N2. A third group was characterized by a slower pattern of maturation with a rate of 11-17%/year and included the AEP peaks P1, N1b, and TP200. The observed latency differences combined with the differences in maturation rate indicate that P2 is not identical to TP200. The results also demonstrated the independence of the T-complex components, represented in the radial dipoles, from the P1, N1b, and P2 components, contained in the tangentially oriented dipole sources.