Brainstem lesions and click lateralization in patients with multiple sclerosis

The ability to lateralize dichotic clicks with either interaural time delays (ITD) or interaural level differences (ILD) was tested in seven multiple sclerosis (MS) subjects who had normal audiograms. Along with the psychoacoustical tests, magnetic resonance images (MRI) of the subjects' brainstem were obtained. After matching each MRI section with the corresponding section of a computerized atlas of the brainstem, the parts of the auditory pathway affected by each MS lesion were determined. Of the seven subjects two performed normally with both types of interaural asymmetry and had no brainstem lesions involving the auditory pathway. Two subjects performed normally only with level differences, but perceived all the dichotic clicks with different ITDs in the center of the head; both had lesions involving the trapezoid body. Three subjects could not perform normally with either task, perceiving the clicks to the sides and never in the center for both ITDs and ILDs; all three had unilateral lesions of the lateral lemniscus. A multi-level decision making model is proposed to account for these results.     

The effect of carrier and modulation frequency on lateralization based on interaural phase and interaural group delay

The sensitivity of Observers to interaural delay in either the envelope or the carrier of an amplitude-modulated sinusoid was measured in a two-interval forced-choice task as a function of the frequency of the modulation and the frequency of the carrier. The two types of delay were set in opposition with the carrier leading in one ear but the modulation leading in the other. Lateralization appeared to be based on carrier (phase) delay when carrier frequency was below 1500 Hz, whatever the modulation frequency. For carrier frequencies greater than 1500 Hz, lateralization performance was dependent both on carrier and on modulation frequency and was based on modulation (group) delay.     

Auditory brainstem responses (ABR) in multiple sclerosis

Thirty-two multiple sclerosis (MS) patients, 10 males and 22 females, aged between 21 and 55, underwent pure-tone audiometry and testing of auditory brainstem response (ABR). Thirteen were classified as 'definite', 12 as 'probable' and 7 as 'possible', according to the McAlpine criteria. Each ear of each patient was tested monoaurally. The most common alterations were seen in the parameters of the cross-correlation between the normal template and the template of the individual MS patient. The second most altered parameters were those concerning the V wave which was absent in most cases but, when present, rarely showed latency-amplitude values falling outside the 90% confidence limit ellipses. Test-retest replicability and stimulations with increasing numbers of stimuli per second were useful in detecting intra-individual variability of waveform characteristics. When considering all the tests performed, 88% of the 'definite', 71% of 'probable' and 64% of 'possible' MS patients' ears showed ABR abnormalities. We stress the importance of a separate evaluation of the two ears due to the frequent unilateral alterations, and of an accurate evaluation of the ABR characteristics. We conclude that brainstem audiometry is a more reliable test for detecting demyelinating processes than is usually described in the literature.     

On the lag of lateralization caused by interaural time and intensity differences

Psychometric measurements with an 80-Hz pulse series signal showed that the lag of sound localization due to interaural intensity-differences is significantly smaller than the due to interaural time-difference.

These results seem to be contradictory to the hypothesis that the ear converts intensity-differences into time-differences before perceiving the direction of the sound sensation.     

Stapedius reflex and brainstem auditory evoked responses in multiple sclerosis patients

The stapedius reflex (SR), its adaptation and the brainstem auditory evoked potential (ABR) were recorded in a group of 53 multiple sclerosis patients. All cases were classified as definite according to Schumacher's criteria, and their grade of disability in Hyllested's system was 1-4: no cases of the gravest (grades 5 and 6) disability were included in the series. The peripheral hearing (pure-tone audiogram and speech threshold) was normal in 44 and slightly impaired in 8 cases. SR was abnormal in 6 (11%) and borderline in 11 (21%), whereas the ABR was considered abnormal in 21 (40%) patients. Deviant SR and ABR findings had only slight or no correlation to clinical data. Intercorrelation between SR and ABR abnormality was better but not implicit and a few cases with deviant ABR showed normal SR: The frequency of abnormal and borderline SR findings was clearly higher in bilateral than in unilateral ABR abnormality. Subclassification of ABR into an upper and a lower type of pathology did not correlate with SR abnormality.     

Effects of sex, age and hearing asymmetry on the interaural differences of auditory brainstem responses

Healthy patients with asymmetric sensorineural hearing loss who had received examination of auditory brainstem responses (ABR) were gathered for retrospective analysis. The effects of sex, age and hearing asymmetry on the interaural differences of ipsilateral ABR were determined by multivariant linear regression. Our results showed that the interaural differences of ABR wave III and wave V latencies were significantly affected by hearing asymmetry but not by sex or age. However, in female subjects younger than 50 years, differences of III-V intervals could be negatively correlated with hearing asymmetry. We suggest that plasticity in the auditory brainstem in younger females might account for asymmetrical peripheral hearing in this group.     

Central auditory processing and word discrimination in patients with multiple sclerosis

Many multiple sclerosis (MS) patients with normal pure tone threshold suffer from difficulties in their hearing especially speech perception in background noise, which is possibly because of incompetence of central auditory processing in this group. Three audiologic tests including gap in noise test (GIN), duration pattern sequence test (DPST) and word discrimination score (WDS) were used for comparing a number of aspects of central auditory processing between patients with MS and normal subjects. Approximate threshold and percent of correct answers in GIN test, percent of correct answers in DPST test and monosyllabic discrimination in WDS test were obtained through cross-sectional non-invasive study conducted on 26 subjects with relapsing-remitting multiple sclerosis who had mean age of 28.9 (SD 4.1) years, and 26 18–40-year-old ones with normal hearing and mean age of 27.7 (SD 5.2). Results of this study demonstrate increased approximate threshold and reduction of percent of correct answers obtained from GIN test in patients with multiple sclerosis (Pv = 0.0001). Furthermore in patients with MS, the average of correct answers in DPST was lower than normal subjects and finally performance of MS subjects in WDS test in quiet environment was correlated with GIN threshold (r = ?/624, Pr = /003). Results of the present study showed that patients with MS had defect in aspects of central auditory processing consisting of temporal resolution, auditory pattern and the memory for auditory task and difficulty in discrimination of speech in noisy environment that are related to the involvement of central nervous system.     

Bone-conducted sound lateralization of interaural time difference and interaural intensity difference in children and a young adult with bilateral microtia and atresia of the ears

Bone-conducted sound lateralization tests to determine interaural time difference (ITD) and interaural intensity difference (IID) were conducted by means of a self-recording apparatus in 20 children and a young adult with bilateral microtia and atresia of the ear. This apparatus changes ITD automatically from 0 to 2,000 micros at 50 micros/s and IID from 1 to 40 dB at 1 dB's. When ITD exceeds approximately 200 micros/s and IID exceeds 5 dB in normal subjects the sounds are recognized separately. The test stimulus was a continuous narrow-band noise at 500 Hz and 30 dB SL applied to the right and left mastoids through bone vibrators. In the patients with bilateral atresia of the ears, ITD results revealed approximately normal thresholds of discrimination in half the patients and IID results revealed threshold elevation in only 10%. It is noted that bone-conducted sound lateralization abilities of ITD or IID are maintained in many of these patients.     

Prediction of binaural click lateralization by brainstem auditory evoked potentials

A previous study by Furst et al. (1985) has shown that in healthy subjects brainstem responses evoked by binaural auditory stimuli with interaural time difference (ITD) and interaural level difference (ILD) include information about the integration of data received by both ears. A correlation was found between the first major peak of the binaural difference waveform and perception of click lateralization and fusion. We have now tested whether a similar correlation exists in patients with multiple sclerosis (MS). The ability to lateralize dichotic clicks was tested in MS patients with normal audiograms. Two kinds of psychoacoustical experiments were employed: (1) A matching experiment in which the subject was asked to match the perceived positions of two click trains, one of which consisted of dichotic clicks with ILD and the other dichotic clicks with ITD; and (2) A positional JND experiment in which the subject was asked to determine the difference in perceived position of two successive click trains. Two reference positions were tested, the head center and the side of the head near the ear, while the control was either on ITD or on ILD. According to the psychoacoustical performances, three groups of patients were identified. Group I consisted of patients who performed normally in all the psychoacoustical experiments. Group II patients were able to lateralize binaural clicks but performed abnormally in the matching experiment and in the position discrimination experiment when the control was on ITD and the reference position was the head center. The patients in Group II performed normally in the discrimination experiments when the control was on ILD, and when the control was on ITD but the reference position was the head side. Group III consisted of those who were not able to perform either one of the psychoacoustical experiments. They perceived the same binaural clicks in different positions in different times. Brainstem auditory potentials evoked by dichotic clicks with different ILDs and ITDs were measured in all the MS patients, and the corresponding binaural difference (BD) waveforms were calculated. Whenever beta, the first major peak of BD, was identified it was used to obtain a physiological matching curve. It was derived by matching an ILD on the basis of similar beta latencies. For every patient, in either Group I or II, the physiological matching curve was very similar to his psychoacoustical matching curve.     

Partial labyrinthectomy approach for brainstem vascular lesions.

Conventional wisdom has typically dictated that the bony labyrinth is an inviolate structure. This notion, however, was successfully challenged following the introduction of the partial labyrinthectomy approach, which was primarily used for the surgical management of cerebellopontine and petrous apex meningiomas. In this article, we discuss an extension of the technique of partial labyrinthectomy in a series of patients that has been used for the treatment of brainstem vascular lesions. We believe that this technique provides superior exposure to the brain stem when compared with conventional retrosigmoid and retrolabyrinthine approaches while reducing the inherent morbidity seen in transotic or petrosectomy approaches.     

The effect of interaural phase on frequency discrimination with broad- and narrow-band maskers

With both broad-band and narrow-band noise maskers there is a small range of signal-to-noise ratios where, with the maskers in-phase and signals 180 degrees out-of-phase at the ears, detection performance grows with increasing signal-to-noise ratio but frequency discrimination performance does not. The observation may have significant consequences for our understanding of the way in which frequency is coded at low signal-to-noise ratios.     

Effects of myelin or cell body brainstem lesions on 3-channel Lissajous' trajectories of feline auditory brainstem evoked potentials

Auditory brainstem evoked potentials (ABEP) were recorded from 16 awake cats to obtain 3-Channel Lissajous' Trajectories (3CLTs) using three orthogonal differential electrode configurations (nasion-midline nuchal ridge, left-right mastoids, vertex-midline under the mandible). Potentials, evoked by monaural 80 dBnHL (re, human threshold) clicks, were studied before, and up to 7 weeks after inducing neuronal lesions localized to the cochlear nucleus (CN) or the superior olivary complex (SOC), or myelin lesions localized to the fibers of the trapezoid body connecting these two structures. Neuronal lesions were induced by injection of kainic acid (KA), while myelin lesions were induced by injection of L-alpha-lysophosphatidylcholine (LPC). With CN neuronal lesions the major changes in 3CLT were in the time domain of 'b', 'c' and 'd' (components P2, P3 and P4 of single-channel ABEP). With SOC neuronal lesions the major changes were in 'c' and 'd' of 3CLT (P3 and P4 of ABEP). With trapezoid body lesions the major change was in 'c' (P3 of ABEP). The results are compatible with the peripheral generation of the first ABEP components (P1a and P1b). The second component (P2) is generated by ipsilateral CN neurones and their outputs. The third component (P3) is generated primarily by ipsilateral SOC neurones and their outputs, with the ipsilateral CN providing input. The The fourth component (P4) is generated bilaterally by the SOC neurones and their outputs, receiving their inputs from ipsilateral CN. The fifth ABEP component (P5) is generated by structures central to the SOCs and their immediate outputs. Neither focal neuronal nor myelin lesions were sufficient to produce obliteration of any component, consistent with a set of generators for each of the ABEP components, consisting of both cell bodies and their output fibers, that is distributed spatially in the brainstem.     

Sound lateralization regarding amplitude and time factors in various forms of hearing loss

The ability to localize the sound source was investigated in 70 patients with hypoacusis of various type and degree, using interaural differences in time and intensity. The dichotic method of signal presentation was employed which made it possible to separately vary sound excitation of each ear. Isolated use of interaural differences in terms of time and amplitude was investigated by measuring lateralization thresholds, i.e. minimal interaural differences in time and intensity perceived as a displacement of the acoustic image from the head midline. It was found that lateralization of the acoustic image in response to interaural time and intensity differences followed different patterns. The precision of time lateralization depended on the level of hearing impairment and on binaural hearing asymmetry with respect to tone perception thresholds. The precision of intensity lateralization was dependent on the type of hypoacusis. The lowest thresholds of intensity lateralization were seen in patients with chronic adhesive otitis while the highest thresholds were detected in patients with 1st degree otosclerosis. It is recommended to use tests for measuring lateralization thresholds in terms of time and intensity in order to perform differential diagnostics of hearing impairment and functional prediction of hearing improvement interventions in otosclerosis and chronic otitis.     

Interference and enhancement effects on interaural time discrimination and level discrimination in listeners with normal hearing and those with hearing loss

It is known that many listeners with sensorineural hearing loss (SNHL) have difficulty performing binaural tasks. In this study, interference and enhancement effects on interaural time discrimination and level discrimination were investigated in 4 listeners with normal hearing (NH) and 7 listeners with SNHL. Just-noticeable differences were measured using 1/3-octave narrowband noises centered at 0.5 and 4 kHz. Noises were presented in isolation and together at equivalent sound pressure level (EqSPL) and equivalent sensation level (EqSL). Each noise served as target and distractor in the dual-band conditions. Congruent conditions included interaural differences in both noises that varied together, and incongruent conditions included an interaural difference in one noise with the second noise diotic. No significant enhancement effects were observed for either group in either task. Interference effects for the NH group were limited to the interaural level discrimination task in the 0.5-kHz target and 4-kHz distractor condition. Performance of participants with SNHL was similar to that of the NH group for interaural time discrimination with noises at EqSL but not EqSPL. In interaural level discrimination, listeners with SNHL demonstrated interference with a 4-kHz target and 0.5-kHz distractor. Results indicated that the relative levels of low- and high-frequency targets and distractors could affect binaural performance of individuals with SNHL but that in some conditions listeners with SNHL performed similarly to those with normal hearing. Implications of these results for binaural clinical tests and hearing aid fitting strategies are discussed.     

Stapedius reflex abnormalities in multiple sclerosis.

Thirteen patients suffering from multiple sclerosis were analyzed by a Madsen ZO 70 electroacoustic bridge connected to an electronystagmograph through an impedance adaptor. Threshold, amplitude, decay and difference limen of intensity (DLI) of the stapedius reflex were examined for the frequencies 500, 1 000, 2 000 and 4 000 Hz. The difference between standard audiometric results and stapedius reflex data stresses the value of reflex measurements in assessing brain stem pathology.     

The effect of brainstem lesions on brainstem auditory evoked potentials in the cat

Brainstem auditory evoked potentials (BAEPs) were recorded before and after cuts were made in either the midline trapezoid body (TB), the lateral lemniscus (LL), or the combined dorsal and intermediate acoustic striae (DAS/IAS) in 23 anesthetized cats. Monaural and binaural rarefaction clicks were presented at a rate of 10 per s, and the potentials recorded from a vertex electrode referenced to either earbar or to the neck. The potentials were filtered so that fast and slow components could be examined separately and special efforts were exerted to obtain stable conditions so that small changes in waveforms could be significant. Lesions of the DAS/IAS produced negligible changes in either the fast or slow waves. Lesions of the midline TB reduced the amplitudes of peaks P3 through P5, while greatly reducing the amplitude of the slow wave. Complete lesions of the LL always reduced the amplitude of the slow wave. Lesions of the ventral part of the LL were more likely to reduce the amplitude of P4-P5. Our interpretations of these lesion experiments are based on the idea that individual fast peaks of the BAEP represent compound action potentials of fiber pathways. According to this view, only synchronized activity generated in populations of neurons that are both favorably oriented in space and significant in number, will contribute to the fast peak.     

Human long-latency potentials evoked by monaural interruptions of a binaural click train: connection to sound lateralization based on interaural intensity differences.

In 9 subjects with normal hearing, monaural offset (MO) responses in the long-latency range were recorded with and without an ongoing sound (click train at a rate of 250/s) at the opposite ear. In the latter case MOs were perceived simply as termination of a sound. In the former case, however, the abrupt transition from binaural to monaural (BM) stimulation was perceived as a shift of the fused image from the center to either side. Therefore, the fairly large difference potential obtained by subtracting the MO response from the BM response was evaluated as the cortical response to stimulation of the sound lateralization mechanism based on interaural intensity differences. These center-to-side responses, which could be characterized by an N1-P2 wave sequence at latencies of 120 and 220 ms, respectively, were compared with the auditory onset responses also recorded from the same subjects by means of a sequential stimulation paradigm. The scalp topography of the N1 components in all these responses recorded simultaneously from frontocentral, parietocentral and two superior temporal electrodes with a neck reference is discussed.     

Anticipatory coarticulation in multiple sclerosis and Parkinson's disease.

Research investigating coarticulatory patterns in dysarthria has the potential to provide insight regarding deficits in the organizational coherence of phonetic events that may underlie deviant perceptual characteristics. The current study investigated anticipatory coarticulation for 17 speakers with multiple sclerosis (MS), 12 speakers with Parkinson's disease (PD), and 29 healthy control speakers. V1-C-V2 sequences were used to investigate intersyllabic vowel to vowel effects (V2 to V1 effects), intersyllabic consonant to vowel effects (C to V1 effects), and intrasyllabic vowel to consonant effects (V2 to C effects). Second formant frequencies and first moment coefficients were used to infer coarticulation. In general, patterns of intersyllabic and intrasyllabic coarticulation were similar for speakers with MS, speakers with PD, and healthy control speakers. It therefore appears unlikely that coarticulatory patterns for speakers diagnosed with MS or PD strongly contribute to deviant perceptual characteristics, at least for the current group of speakers, most of whom were mildly to moderately impaired. Anticipatory vowel effects in /k/+vowel sequences, however, tended to be reduced for speakers with MS and speakers with PD when data for these 2 speaker groups were pooled and compared to control speakers. These results were not attributable to group differences in speech rate or articulatory scaling, defined as the extent of articulatory movements, and further suggest that coarticulatory deficits are not unique to particular neurological diagnoses or dysarthrias. Potential explanations for the /k/+vowel results include difficulties with anterior-posterior tongue positioning and the competing influences of minimizing articulatory effort and maintaining sufficient perceptual contrast. Despite this subtle difference in coarticulation between disordered speakers and healthy control speakers, the overall results suggest that anticipatory coarticulation for speakers with MS and speakers with PD is preserved.