Pre-perioperative, transtympanic electrically evoked auditory brainstem response in children

The purpose of this study was to characterize the transtympanically evoked, perioperative electrically evoked auditory brainstem response (EABR) and define its relationship with preoperative hearing, age and hearing loss etiology in 59 children (10-60 months of age) who had received cochlear implants. The results indicate that there was no difference between wave V latency obtained from the younger (10-36 months) and the older (37-60 months) children. There was a statistically significant difference in the preoperative pure-tone average between the higher-EABR threshold group (650 microA and above) and the lower-EABR threshold group (600 microA or less). Patients with post-meningitic deafness exhibited the longest EABR wave V latencies. Perioperative, transtympanic, promontory EABR is an effective clinical procedure which can decrease the likelihood of placing a cochlear implant in a non-stimulable ear, and may provide the clinician with a valuable tool for selecting the most appropriate ear for implantation.     

Stacked tone-burst-evoked auditory brainstem response (ABR): preliminary findings

In 1997, Don and his co-workers described a new method for evaluating the auditory brainstem response (ABR)--yielding the stacked-wave-V ABR--which may permit the reliable detection of even small vestibular schwannomas (VSs). However, this method requires a masking technique that may not be readily available to the clinician. Furthermore, relatively high-level noise is required and may be annoying to the patient. An alternative method that might permit the same manipulation of the ABR was thus explored whereby tone-bursts (TBs) were used to obtain frequency-specific ABRs. The goal of the study was to determine whether TBs could be used to achieve the sort of de-convolution and subsequent enhancement of wave V reported with the original method of Don et al. First, the TB-stacked ABR (wave V) was compared to that obtained using derived narrowband masked ABRs in young normal-hearing subjects. Second, the TB method was employed in subjects with unilateral VSs and in patients with unilateral sensory hearing loss in a preliminary clinical trial. The observed results are promising for the use of the TB method as an alternative approach to ABR 'stacking' and warrant further research and development of the TB method.     

Postnatal development of the auditory brainstem response (ABR) in the unanesthetized gerbil

The auditory brainstem response (ABR) was used to study the development of 8th nerve and auditory brainstem function in 71 unanesthetized gerbils. Initial replicable responses were observed on day 14. Six vertex-positive waves and a slow negative response (SNR) were obtained in response to a 100 dB HL (re adult threshold) click stimulus on day 20. A general pattern of development characterized by decreasing threshold and wave latencies and increasing amplitudes was found. Latency changes occurred in two stages; rapid decreases in the third postnatal week, followed by a period of gradual decline toward adult latencies during the fourth and fifth weeks. Greater changes in absolute latency were observed for later waves. Development of adult-like thresholds and resistance of response detectability (presence or absence) to increasing stimulus rates occurred prior to or simultaneous with maturation of wave latencies. Increases in amplitude with age continued to adulthood for waves IV and SNR, while other waves declined in amplitude after day 20. The maturation of the ABR overlapped with the emergence and development of the auditory middle latency response (MLR). Waves B (adult latency 16 ms) and C (adult latency 25 ms) were discernable at approximately the same age that a replicable ABR was first obtained, and wave A (adult latency 14 ms) shortly thereafter. The general pattern of decreasing ABR wave thresholds and latencies with age seen in the gerbil is similar to that found in other mammals, including humans. However, the development of mature response characteristics appeared to proceed at a somewhat independent rate among the different ABR and MLR waves. The emergence of the MLR before several ABR waves suggests that development of auditory function in the gerbil may not follow a strictly sequential pattern.     

Estimation of surviving auditory nerve by electrically evoked auditory brainstem response (FABR)--comparison between extra-cochlear stimulation and intra-cochlear stimulation

This study investigated the possibility of using electrically evoked auditory brainstem response (EABR) for predicting surviving spiral ganglion cell populations. EABR recordings were made from six kanamycin induced deaf cats by the round window monopolar stimulation (RW) and the scala tympani bipolar stimulation (ST). On completing the electrical stimulation, each animal was sacrificed and prepared for histological examination. The spiral ganglion cell populations were estimated by classifying them into four groups (0-25%, 25-50%, 50-75%, 75-100%) as a percentage of survival cells under magnification. EABR thresholds and input-output function of amplitude were compared with microscopic findings of surviving spiral ganglion cell populations. The results were as follows: 1) The rate of amplitude growth in response to increased stimulus intensity of electrically evoked potentials from ST was gradual, but that of RW was steep. 2) The vestibular potentials were elicited by RW, and at a lower stimulus intensity the RW waveform began to become distorted by the myogenic potentials. 3) EABR threshold was a poor predictor of surviving spiral ganglion cell populations. 4) There was a correlation between surviving spiral ganglion cell populations and the slope of the input-output functions of ST EABR. However, there was no correlation between that of RW EABR and the slope.     

Age-related auditory brainstem response (ABR) threshold changes in the dancer mouse mutant

An age-related analysis of auditory brainstem response (ABR) thresholds in 42 heterozygotic dancer mouse mutants (1-13 months old) showed an impairment of ABR thresholds with increasing age, though individual threshold curves could vary considerably. As compared with normal CBA/CBA mice, a progressive deterioration of ABR thresholds occurred from the 2nd postnatal month onwards. The dancer mutant has an inner ear with a morphogenetic type of defect, caused by a semidominant gene which is located in chromosome 19.     

电诱发听性脑干反应（EABR）的临床应用

电诱发听性脑干反应（electrically evoked auditory brainstem responses,EABR）是一种客观的神经电生理检测方法．在耳科学、听力学和神经科学中占有重要的地位。EABR可以估测耳聋患者残存的听神经末梢螺旋神经节数量．客观评价听觉传导通路的功能状态．指导人工耳蜗植入手术及听性脑干植入手术．并在术后设备调试中起重要作用。本文对EABR的临床应用现状及前景做一综述。     

Influences of birthweight upon brainstem maturation as reflected by auditory brainstem response (ABR) evaluation

The authors have studied auditory brainstem responses (ABR) in 49 preterm (Group A) and in 54 fullterm (Group B) newborns, classified according to the birthweight related to conceptional age, in order to verify the influences of this latter parameter upon ABR. In Group A newborns, 4 recording sessions were performed, while only 3 in Group B, to evaluate data obtained at the same extra-uterine age. The obtained data show that birthweight related to conceptional age seems to play a major role on the development of ABR, since no significant differences were detected between preterm and fullterm newborns, provided the birthweight was appropriate for conceptional age (ACA). On the contrary, small for conceptional age (SCA) newborns showed an abnormal ABR pattern at birth, which tended to normalize at the following recording sessions. The authors conclude that birthweight related to conceptional age represents an important factor in the development of auditory brainstem responses and that the audiological diagnosis has to be very cautious in SCA newborns, regardless if they are pre- or fullterm.     

Comparison of electrically evoked whole-nerve action potential and electrically evoked auditory brainstem response thresholds in nucleus CI24R cochlear implant recipients

In this study, differences between electrically evoked whole-nerve action potential (EAP) and electrically evoked auditory brainstem response (EABR) measurements within Nucleus CI24R cochlear implant recipients were evaluated. Precurved modiolus-hugging internal electrode arrays, such as the CI24R, are designed to provide more direct stimulation of neural elements of the modiolus. If the electrode array is closer to the modiolus, electrically evoked and behavioral levels might be lower than were previously recorded for the straight electrode array, the CI24M. EAP and EABR growth functions and behavioral levels were obtained for 10 postlingually deafened adults. Results revealed no significant differences between EAP and EABR threshold levels, and these levels were not significantly lower than those obtained using the CI24M.     

Comparisons of the development of auditory brainstem response latencies between cats and humans.

Developmental changes in the peak latencies of auditory brainstem responses (ABR) recorded from humans and kittens were compared to test the hypothesis that developmental time courses among mammals are the same when appropriately normalized. Response latencies were computed as the difference from adult latency and conceptional ages were represented as percentages relative to the age that ABR wave latencies achieved a criterion value within 0.2 ms of asymptotic latency (i.e., adulthood). An underlying assumption of this exercise is that far-field response latency is an appropriate index of overall 'auditory development'. Results of this analysis suggest that developmental changes in latency of responses arising within the auditory periphery are similar between humans and cats, when appropriately normalized, and that more central changes show less correspondence. Consequently, absolute time course differences for specific developmental parameters must be considered and caution should be exercised when extrapolating results acquired from one species to the other.     

The effect of sleep on the auditory brainstem response (ABR) and the middle latency response (MLR)

The ABR and the MLR were measured without interruption in 4 subjects during a whole night of natural sleep and compared with the awake responses. The conventional EEG activity was monitored during the whole procedure, which permitted a precise rating of the sleep stage during each recording period. Only minor changes were found in the latencies for the ABR during sleep. The MLR responses showed quite dramatic changes in morphology and latencies. Our results appear to indicate that the 40/sec stimulus presentation mode of the MLR will not be very effective during sleep due to the pronounced latency shifts of the different peaks in the MLR. The 40/sec response is based on an inter-peak latency of 25 msec. If this presumption is not fulfilled the different waves in the 40/sec response will not be superimposed and consequently enhanced in the averaging procedure.     

Effect of stimulation parameters on electrically evoked auditory brainstem responses

It is evident that the conventional technique for cochlear implant adjustment is not suitable for children in their first years of life. In order to find a solution to this problem, the possibility of electrically evoked auditory brainstem response (EABR) recording was investigated. EABRs were recorded in 9 patients with the Nucleus multichannel cochlear implant. The main problems that have to be solved during EABR recording in cochlear implantees are: i) EABR distortion due to the stimulus artefact: and ii) difference in the stimulus presentation rate during EABR registration (low pulse rate) and conventional psychophysical threshold estimation (high pulse rate) in cochlear implant patients. The influence of stimulus artefact on the recording results was minimized by setting the implant to the widest amplifier frequency band and by zeroing the initial segment containing the stimulus artefact with subsequent zero-phase digital filtering. The dependence of the EABR amplitude and latency on the stimulus intensity, width, electrode location and interstimulus interval was investigated. It was concluded that despite the difference revealed between absolute values of EABR thresholds and psychophysical threshold levels, it is possible to calculate implant adjustment parameters based on the EABR data with the proper correction applied.     

持续进行性口吃患者的言语声诱发听性脑干反应

持续进行性口吃(persistent developmental stuttering,PDS)是一种儿童时期发病至成人仍不恢复的言语流畅障碍性疾病,发病机制至今尚未明确.一些电生理学研究表明口吃患者存在着听觉皮层的功能障碍,其听觉信息处理缺陷被认为是其基础机制.最近神经学研究发现,PDS患者皮层下中枢的听觉和运动区(例如基底神经节)出现异常神经活动.有学者指出,听觉脑干可能是PDS患者听觉中枢功能的缺陷部位.     

Estimation of surviving spiral ganglion cells in the deaf rat using the electrically evoked auditory brainstem response

A procedure was developed to record the electrically evoked auditory brainstem response (EABR) in the rat with sufficiently little stimulus artifact to permit systematic measurements of the first positive wave (P1), the compound action potential (CAP) of the auditory nerve. Our principal aim was to verify the theoretical prediction that maximum P1 amplitude is directly proportional to the number of excitable auditory nerve fibers. This was carried out in animals with graded lesions of the spiral ganglion induced by perfusion of the cochlea with different concentrations of neomycin. Two series of observations confirmed the theoretical prediction. Several measures of P1, including maximum amplitude, and slopes of the P1 and P1-N1 growth functions, were highly correlated with the number of surviving spiral ganglion cells. Correlation coefficients (r) ranged from 0.75 to 0.92. Amplitudes of the later waves exhibited much lower correlations with spiral ganglion cell counts. These findings suggest that measurement of the CAP in deaf humans, possibly as wave I of the EABR, should provide quantitative information about the status of the nerve, which could be useful in screening candidates for cochlear implants, prescribing the optimum device for individual patients, and determining how benefits derived from such devices relate to the condition of the auditory nerve.     

Estimation of surviving spiral ganglion cells in the deaf rat using the electrically evoked auditory brainstem response

A procedure was developed to record the electrically evoked auditory brainstem response (EABR) in the rat with sufficiently little stimulus artifact to permit systematic measurements of the first positive wave (P1), the compound action potential (CAP) of the auditory nerve. Our principal aim was to verify the theoretical prediction that maximum P1 amplitude is directly proportional to the number of excitable auditory nerve fibers. This was carried out in animals with graded lesions of the spiral ganglion induced by perfusion of the cochlea with different concentrations of neomycin. Two series of observations confirmed the theoretical prediction. Several measures of P1, including maximum amplitude, and slopes of the P1 and P1-N1 growth functions, were highly correlated with the number of surviving spiral ganglion cells. Correlation coefficients (r) ranged from 0.75 to 0.92. Amplitudes of the later waves exhibited much lower correlations with spiral ganglion cell counts. These findings suggest that measurement of the CAP in deaf humans, possibly as wave I of the EABR, should provide quantitative information about the status of the nerve, which could be useful in screening candidates for cochlear implants, prescribing the optimum device for individual patients, and determining how benefits derived from such devices relate to the condition of the auditory nerve.     

Myogenic influences on the electrical auditory brainstem response (EABR) in humans

Two cases demonstrating the effects of myogenic artifact on the electrical auditory brainstem response (EABR) when using a promontory stimulation site are presented. Intensity-response functions were obtained in the unparalyzed condition, then repeated after infusion of a neuromuscular paralyzing agent. In both cases, the myogenic response was observed at lower stimulus intensities than the EABR components. As intensity increased, the myogenic responses grew at extremely rapid rates and made any subsequent identification of auditory responses virtually impossible. To alleviate the adverse influence of myogenic components, general anesthesia and a paralyzing agent must be incorporated into the test protocol when acquiring the EABR using a promontory site of stimulation.     

Functional development of the auditory brainstem in the tammar wallaby (Macropus eugenii): the superior olivary complex and its relationship with the auditory brainstem response (ABR)

Twenty pouch-young tammar wallabies (Macropus eugenii) were used to determine the generator of the auditory brainstem response (ABR) during development through ABR and focal superior olivary complex (SO) recordings. A click response from the SO in the wallaby was recorded from postnatal day (PND) 112 when the ABR was only a positive-negative deflection. Before PND 120, the SO response did not contribute to the ABR as it occurred outside the ABR time-span. After PND 140, the SO response was correlated with multiple waves of the ABR with its dominant component corresponding to the ABR P3 wave. The latency, threshold, and amplitude of the SO response developed to the adult-like level at PND 140, while the rate-following ability in the SO response reached the adult level at PND 160. Presumably this was due to more complicated mechanisms underlying the auditory adaptation. The adaptation of the SO response was directly proportional to the stimulus rate and intensity as well as developmental status. Developmental comparison between the ABR and the focal responses from four auditory brainstem nuclei indicated that each ABR component may have a dominant contributor from the auditory brainstem, but there was no simple and exclusive association between the ABR component and the auditory brainstem nuclei.     

Chloral hydrate sedation for auditory brainstem response (ABR) testing in children: Safety and effectiveness

IntroductionThe auditory brainstem response (ABR) test is used to identify hearing loss and measure hearing thresholds of infants and children who cannot be tested using standard behavioral hearing testing methods. In order for the ABR to yield useful data, a child must be asleep throughout the duration of the test. In many centers, this is achieved through the use of a general anesthetic, with its inherent risks and costs. Since 2004, ABRs have been routinely conducted at BC Children's Hospital in an ambulatory care setting under oral chloral hydrate sedation, with monitoring by a specialist nurse. The aim of this retrospective study was to assess the effectiveness and safety of nurse-led sedation with chloral hydrate for ABR testing at our tertiary pediatric center.MethodsMedical and audiology records were reviewed for children aged 6 months to 17 years who underwent ABR testing from 2004 to 2012. We reviewed the dosage of drug used, condition of the child after chloral hydrate administration, adverse effects, audiological results, patients’ vital signs, and the effectiveness of the sedative in keeping the child asleep throughout the duration of the test. Frequency distributions were derived for adverse outcomes.Results725 ABR records encompassing 635 children (multiple ABR tests in some children) were reviewed. The average dose of chloral hydrate used was 52 mg/kg. The majority of sedated ABR's (80.8%) were completed without any incident. Significant events [apnea and/or bradycardia], minor complications [vomiting, hypoxemia, prolonged sedation, and/or tachypnea] and restlessness were noted in 3.4%, 6.2%, and 5.0% of the cases, respectively. The majority of these issues resolved without medical intervention, such as the need to provide supplementary oxygen. In 95.9% of ABRs, chloral hydrate was successful in sedating the child adequately to answer the audiological question.ConclusionsThis forms the largest study to date on oral sedation for ABR testing. Based on our results, the use of chloral hydrate in the presence of a sedation nurse was a safe and reliable method of performing ABR in infants and children. This may be of significant value to centres worldwide exploring alternatives to general anesthesia for ABR testing.