Speech evoked auditory brainstem response findings in children with epilepsy

Objectives

Children with epilepsy are at a considerable risk of cognitive impairment and school failure. Previous studies have typically documented abnormal responses in children with epilepsy at cortical level using speech stimuli. Recent studies reported that abnormal neural encoding of a speech syllable could be detected at the level of the brainstem using speech-evoked auditory brainstem response (ABR). The aim of this study is to investigate speech-evoked (ABR) results in children with epilepsy.

Methods

The study group consisted of 38 recently diagnosed epileptic children; none of them has received antiepileptic therapy. They were 22 males and 16 females with age 9.1 ± 3.1 years. The control group consisted of 38 healthy normal hearing children with matched age and gender distribution. All subjects underwent full history taking, basic audiologic evaluation including pure-tone, speech audiometry and immittance testing. Click ABR response was recorded monaurally from both ears at 90 dB nHL then speech ABR was recorded monaurally from each ear at 80 dB SPL.

Results

Though the study group disclosed normal click ABR compared to age matched normative values, speech-evoked ABR revealed a delayed waves V and A latencies in both ears. These findings reflect abnormal neural encoding of speech at the level of brainstem. The younger the age of epileptic child the more prolonged wave A latency and increased V/A inter-latency values.

Conclusions

Speech-evoked ABR results denote abnormal timing in the brainstem; such brainstem abnormality could be detected by speech evoked ABR rather than conventional click evoked ABR.     

Test-retest consistency of speech-evoked auditory brainstem responses in typically-developing children

The click-evoked auditory brainstem response (ABR) is widely used in clinical settings, partly due to its predictability and high test-retest consistency. More recently, the speech-evoked ABR has been used to evaluate subcortical processing of complex signals, allowing for the objective assessment of biological processes underlying auditory function and auditory processing deficits not revealed by responses to clicks. Test-retest reliability of some components of speech-evoked ABRs has been shown for adults and children over the course of months. However, a systematic study of the consistency of the speech-evoked brainstem response in school-age children has not been conducted. In the present study, speech-evoked ABRs were collected from 26 typically-developing children (ages 8-13) at two time points separated by one year. ABRs were collected for /da/ presented in quiet and in a 6-talker babble background noise. Test-retest consistency of response timing, spectral encoding, and signal-to-noise ratio was assessed. Response timing and spectral encoding were highly replicable over the course of one year. The consistency of response timing and spectral encoding found for the speech-evoked ABRs of typically-developing children suggests that the speech-evoked ABR may be a unique tool for research and clinical assessment of auditory function, particularly with respect to auditory-based communication skills.     

On the relationship between speech- and nonspeech-evoked auditory brainstem responses

Auditory brainstem response (ABR) reflects activation of the neural generators along the ascending auditory pathway when a sound is heard. In this study, we explored the relationship between brainstem encoding of click and speech signals in normal-learning children and in those with language-based learning problems. To that end, ABR was recorded from both types of stimuli. We found that the normal pattern of correlation between click- and speech-evoked ABRs was disrupted when speech-evoked ABRs were delayed. Thus, delayed responses to speech were not indicative of clinically abnormal responses to clicks. We conclude that these two responses reflect largely separate neural processes and that only processes involved in encoding complex signals such as speech are impaired in children with learning problems.     

An evoked potential study of the developmental time course of the auditory nerve and brainstem in children using cochlear implants

Central auditory responses to electrical stimulation from a cochlear implant were studied in 75 pre-lingually deafened children and 11 adults. Electrically evoked auditory brainstem response (EABR) latencies significantly decreased with duration of cochlear implant use and were not significantly affected by the age at implant activation. Significant decreases in early latency waves and interwaves occurred within the first 1-2 months of implant use, whereas longer term changes (6-12 months) were found for eV and eIII-eV, which measure activity in the more rostral brainstem. Comparisons to acoustically evoked auditory brainstem response (ABR) in children with normal hearing suggested shorter interwave EABR latencies, reflecting either distinct neural generators or increased neural synchrony, but similar rates of change in the later latency eV and eIII-eV with time in sound. In sum, normal-like development of the rostral auditory brainstem is promoted by cochlear implant use in children of a wide range of ages.     

Speech evoked auditory brainstem responses: a new tool to study brainstem encoding of speech sounds

The neural encoding of speech sound begins in the auditory nerve and travels to the auditory brainstem. Non speech stimuli such as click or tone bursts stimulus are used to check the auditory neural integrity routinely. Recently Speech evoked Auditory Brainstem measures (ABR) are being used as a tool to study the brainstem processing of Speech sounds. The aim of the study was to study the Speech evoked ABR to a consonant vowel (CV) stimulus. 30 subjects with normal hearing participated for the study. Speech evoked ABR were measured to a CV stimulus in all the participants. The speech stimulus used was a 40?ms synthesized/da/sound. The consonant and vowel portion was analysed separately. Speech evoked ABR was present in all the normal hearing subjects. The consonant portion of the stimulus elicited peak V in response waveform. Response to the vowel portion elicited a frequency following response (FFR). The FFR further showed a coding of the fundamental frequency (F0) and the first formant frequency (F1). The results of the present study throw light on the processing of speech in brainstem. The understanding of speech evoked ABR has other applications both in research as well as in clinical purposes. Such understanding is specially important if one is interested in studying the central auditory system function.     

Sensory-based learning disability: Insights from brainstem processing of speech sounds

Speech-evoked auditory brainstem responses (speech-ABR) provide a reliable marker of learning disability in a substantial subgroup of individuals with language-based learning problems (LDs). Here we review work describing the properties of the speech-ABR in typically developing children and in children with LD. We also review studies on the relationships between speech-ABR and the commonly used click-ABR, and between speech-ABR and auditory processing at the level of the cortex. In a critical examination of previously published data, we conclude that as many as 40% of LDs have abnormal speech-ABRs and that these individuals are also likely to exhibit abnormal cortical processing. Yet, the profile of learning problems these individuals exhibit is unspecific. Leaving open the question of causality, these data suggest that speech-ABR can be used to identify a large sub-population of LDs, those with abnormal auditory physiological function. Further studies are required to determine the functional relationships among abnormal speech-ABR, speech perception, and the pattern of literacy-related and cognitive deficits in LD.     

Sensory-based learning disability: Insights from brainstem processing of speech sounds

Speech-evoked auditory brainstem responses (speech-ABR) provide a reliable marker of learning disability in a substantial subgroup of individuals with language-based learning problems (LDs). Here we review work describing the properties of the speech-ABR in typically developing children and in children with LD. We also review studies on the relationships between speech-ABR and the commonly used click-ABR, and between speech-ABR and auditory processing at the level of the cortex. In a critical examination of previously published data, we conclude that as many as 40% of LDs have abnormal speech-ABRs and that these individuals are also likely to exhibit abnormal cortical processing. Yet, the profile of learning problems these individuals exhibit is unspecific. Leaving open the question of causality, these data suggest that speech-ABR can be used to identify a large sub-population of LDs, those with abnormal auditory physiological function. Further studies are required to determine the functional relationships among abnormal speech-ABR, speech perception, and the pattern of literacy-related and cognitive deficits in LD.     

Auditory brainstem responses in noise-induced permanent hearing loss

Fifty-four patients (108 ears) with presumed noise-induced hearing loss, were subjected to tonal and speech audiometry, impedance tests and measurements of auditory brainstem responses (ABR), in order to check for possible retrocochlear involvement. ABR data indicated that latency values of waves I, III and V, as well as III-I, V-III and V-I intervals fell within the normal range in all cases (M +/- 2 SD), even for fast repetition rates (51 stim/s). Poor waveform resolution of early components, particularly of wave I, was found in 12 ears (11.1%) and a total absence of evoked potentials not always related to the hearing loss, occurred in 5 ears (4.6%).     

Evaluation of brainstem function in patients with spasmodic dysphonia using vestibular evoked myogenic potentials and auditory brainstem responses

CONCLUSION: The vestibular area is closer than the auditory region to nucleus ambiguus. If a 'shared' lesion involves regions of adjacent nuclei of the brainstem in patients with spasmodic dysphonia then vestibular area involvement is more possible than that of the auditory region. OBJECTIVES: The authors hypothesize that lower brainstem lesions and involvement of descending pathways of the spinal tract may be the site of lesion in patients with spasmodic dysphonia. PATIENTS AND METHODS: Ten patients with spasmodic dysphonia were tested using the auditory brainstem response (ABR) and vestibular evoked myogenic potentials (VEMPs). RESULTS: No ABR abnormalities were found in right ears. Results of ABR on the left ear showed that one patient had abnormal ABR. This patient had severe sensorineural hearing loss on the left side. VEMPs displayed normal response in two patients bilaterally. First positive (p13) and second negative (n23) waves of VEMP could not be recorded in three cases unilaterally and in five patients bilaterally.     

Audiologic Diagnosis of Central versus Eighth Nerve and Cochlear Auditory Impairment

122 subjects divided into four groups according to the site of lesion (cochlea, eighth nerve, brainstem and temporal lobe) were subjected to an audiometric test battery, including pure-tone sensitivity measures, recruitment testing, tone decay, Békésy audiometry, speech audiometry, stapedius reflex measures and auditory brainstem response (ABR) audiometry. The results were contrasted among the four groups by calculating several measures of test performance, including sensitivity, specificity, efficiency, A' (test performance) and plots on the receiver operating characteristic (ROC) space of pure positives versus false alarms. In the differential diagnosis between eighth nerve and cochlear site, the various measures did not rank the tests in the same order: (a) for efficiency: ABR, Békésy audiometry; (b) for A' (similarly to the analysis into the ROC space): ABR, recruitment, Békésy, stapedius reflex, speech audiometry, tone decay. In distinguishing an eighth nerve from a brainstem site, it is important to consider amount of hearing loss, presence of tinnitus, abnormal tone decay and Békésy audiometry patterns. ABR adds significant diagnostic efficiency only when waves II, III and V are detectable: a prolonged I–II interpeak interval (IPI) and a normal III-V IPI are characteristic of the eighth nerve site. ABR gives good diagnostic support in the intrinsic brainstem lesions by suggesting changes in the generator sites of the component waves. The audiometric diagnosis of temporal lobe lesions involving the auditory cortex still relies upon speech audiometry: tests specifically designed for this purpose by Bocca and Calearo and by Jerger - i.e. the 'sensitized sentences' and the identification of synthetic sentences under ipsi- or contralateral competing message - are commendable for their sensitivity and efficiency in distinguishing brainstem from temporal lobe sites. In brainstem sites, the most affected ear is ipsilateral to the lesion for ABR, but contralateral for speech audiometry.     

Audiologic diagnosis of central versus eighth nerve and cochlear auditory impairment

122 subjects divided into four groups according to the site of lesion (cochlea, eighth nerve, brainstem and temporal lobe) were subjected to an audiometric test battery, including pure-tone sensitivity measures, recruitment testing, tone decay, Békésy audiometry, speech audiometry, stapedius reflex measures and auditory brainstem response (ABR) audiometry. The results were contrasted among the four groups by calculating several measures of test performance, including sensitivity, specificity, efficiency, A' (test performance) and plots on the receiver operating characteristic (ROC) space of pure positives versus false alarms. In the differential diagnosis between eighth nerve and cochlear site, the various measures did not rank the tests in the same order: (a) for efficiency: ABR, Békésy audiometry; (b) for A' (similarly to the analysis into the ROC space): ABR, recruitment, Békésy, stapedius reflex, speech audiometry, tone decay. In distinguishing an eighth nerve from a brainstem site, it is important to consider amount of hearing loss, presence of tinnitus, abnormal tone decay and Békésy audiometry patterns. ABR adds significant diagnostic efficiency only when waves II, III and V are detectable: a prolonged I-II interpeak interval (IPI) and a normal III-V IPI are characteristic of the eighth nerve site. ABR gives good diagnostic support in the intrinsic brainstem lesions by suggesting changes in the generator sites of the component waves. The audiometric diagnosis of temporal lobe lesions involving the auditory cortex still relies upon speech audiometry: tests specifically designed for this purpose by Bocca and Calearo and by Jerger - i.e. the 'sensitized sentences' and the identification of synthetic sentences under ipsi- or contralateral competing message - are commendable for their sensitivity and efficiency in distinguishing brainstem from temporal lobe sites. In brainstem sites, the most affected ear is ipsilateral to the lesion for ABR, but contralateral for speech audiometry.     

Auditory brainstem response in ototoxic deafness

Auditory brainstem response (ABR) had been measured in 56 patients with ototoxic deafness (OD) and 20 healthy children. It was found that the ABR change in the OD group was characterized by the disappearance of waves I, III, V and the prolongation of the latencies. The values of ABR in early diagnosis and evaluation of auditory damage in OD were discussed.     

Gender differences in binaural speech-evoked auditory brainstem response: are they clinically significant?

IntroductionBinaurally evoked auditory evoked potentials have good diagnostic values when testing subjects with central auditory deficits. The literature on speech-evoked auditory brainstem response evoked by binaural stimulation is in fact limited. Gender disparities in speech-evoked auditory brainstem response results have been consistently noted but the magnitude of gender difference has not been reported.ObjectiveThe present study aimed to compare the magnitude of gender difference in speech-evoked auditory brainstem response results between monaural and binaural stimulations.MethodsA total of 34 healthy Asian adults aged 19–30 years participated in this comparative study. Eighteen of them were females (mean age = 23.6 ± 2.3 years) and the remaining sixteen were males (mean age = 22.0 ± 2.3 years). For each subject, speech-evoked auditory brainstem response was recorded with the synthesized syllable /da/ presented monaurally and binaurally.ResultsWhile latencies were not affected (p > 0.05), the binaural stimulation produced statistically higher speech-evoked auditory brainstem response amplitudes than the monaural stimulation (p < 0.05). As revealed by large effect sizes (d > 0.80), substantive gender differences were noted in most of speech-evoked auditory brainstem response peaks for both stimulation modes.ConclusionThe magnitude of gender difference between the two stimulation modes revealed some distinct patterns. Based on these clinically significant results, gender-specific normative data are highly recommended when using speech-evoked auditory brainstem response for clinical and future applications. The preliminary normative data provided in the present study can serve as the reference for future studies on this test among Asian adults.     

Lateral asymmetry in the ABR of neonates: evidence and mechanisms

Lateralized processing of auditory stimuli occurs at the level of the auditory cortex but differences in function between the left and right sides are not clear at lower levels of the auditory system. The current study is designed to (1) investigate asymmetric auditory function at the ear and brainstem in human infants and (2) investigate possible mechanisms for asymmetry at these levels. Study 1 evaluated auditory brainstem responses (ABRs) in response to high and low-level clicks presented to the right and left ears of neonates. Wave V was significantly larger in amplitude and waves III and V were shorter in latency when the ABR was generated in the right ear. Study 2 investigated two possible mechanisms of such asymmetry by (a) using contralateral white noise masking to activate the medial olivocochlear system and (b) increasing stimulus rate to reveal neural conduction and synaptic mechanisms. ABR wave V, evoked by clicks to the left ear, showed a greater reduction in amplitude with contralateral noise than the response evoked from the right ear. No systematic asymmetries in ABR latencies or amplitudes were found with increased stimulus rate. We conclude that (1) the click-evoked ABR in neonates demonstrates asymmetric auditory function with a small but significant right ear advantage and (2) asymmetric activation of the medial olivocochlear system, specifically greater contralateral suppression of ABR produced by the left ear, is a possible mechanism for asymmetry.     

Otoakustische Emissionen, Hirnstammpotentiale, Tonschwellengehör und Sprachverständlichkeit bei auditorischer Neuropathie

The combined findings of "normal evoked otoacoustic emissions (EOAE) and absent or markedly disturbed auditory evoked potentials from the brainstem and/or cortex" has been named auditory neuropathy in the English literature. The pure tone thresholds in these patients range from mild to severe loss. The loss of speech comprehension is out of proportion in comparison to the pure tone threshold elevation. This combination of findings suggests that cochlear function and in particular outer hair cell function, is normal in these patients but also suggests that the inner hair cell / VIII nerve functional unit is abnormal. Disruption in neural synchrony has previously been postulated as a reasonable explanation for the absent auditory brainstem response while otoacoustic emissions are preserved. Because the long-latency auditory evoked potentials, not having the stringent synchrony requirements of the ABR, may also be missing, the term synchrony - disruption may be somewhat misleading. The literature about auditory neuropathy is reviewed here: We now know that a set of salient features distinguishes these patients from the majority of patients with sensorineural hearing loss or other described syndromes. The symptoms defining auditory neuropathy are mild, moderate or severe elevation of auditory thresholds to pure tone stimuli by air and bone conduction, absent to severely abnormal ABRs to high level stimuli, present otoacoustic emissions (that do not suppress with contralateral noise), word recognition ability poorer than expected from the pure tone hearing loss configuration (in cases with mild to moderate hearing threshold elevation) and absent acoustic reflexes to both ipsilateral and contralateral tones. The entire set of findings, consistently seen in these patients, supports the importance of the crosscheck principle in diagnostic evaluation especially in children with delayed and/or impaired language acquisition. It is of ponderous importance that this disorder is not being confused with sensory hearing loss.     

孤独症患儿听性脑干反应结果分析

目的探讨孤独症患儿听性脑干反应(ABR)的特点。方法对12例孤独症患儿分别进行声导抗、畸变产物耳声发射(DPOAE)、40Hz相关电位及听性脑干反应(ABR)测试,并对其中3例ABR异常者进行分析。结果 12例双耳均为A型鼓室导抗图,双耳同侧及对侧声反射均可引出,DPOAE均可正常引出,40Hz相关电位500、1 000Hz阈值均≤25dB nHL;12例ABR反应阈均正常,其中9例波形分化好,重复性好,各波潜伏期及波间期正常;3例ABR表现异常:1例双耳波Ⅱ以后各波潜伏期延长;1例双耳Ⅰ-Ⅲ波间期延长;1例双耳波Ⅰ潜伏期正常,波Ⅲ后各波潜伏期、波间期缩短。结论部分孤独症患儿虽中耳及耳蜗功能正常,但其脑干及下丘之间中枢听传导通路可能异常,故对孤独症患者应常规行听功能检测。     

Cochlear implantation of auditory neuropathy

Auditory neuropathy (AN) is a hearing disorder that presents with a grossly abnormal or absent neural response as measured by evoked potentials in the presence of normal outer hair cell function evidenced by present otoacoustic emissions or cochlear microphonics. Rehabilitation for patients with AN is challenging due to abnormal temporal encoding at the auditory nerve leading to severely impaired speech perception. Although patients with AN may demonstrate improvement in thresholds with amplification, temporal encoding dysfunction, and consequently speech perception degradation, is not alleviated by amplification. Another issue is the heterogeneity of the AN population in terms of audiologic and neurologic findings, in addition to uncertain etiology and pathophysiology. For children with prelingual onset of AN, development of auditory and oral communication skills is particularly compromised. All children with hearing loss in the severe-to-profound range who do not benefit from conventional amplification can be considered candidates for a cochlear implant (CI). This paper presents a case study of a child with AN who received a CI. Whereas no synchronous neural response auditory brainstem response could be elicited to acoustic stimuli, an electrically evoked auditory nerve action potential was evident following implantation, suggesting restoration to some degree of neural synchrony. Significant improvement in speech perception was found post-CI. Recommendation to implant all patients with AN would be premature, but these findings suggest that electrical stimulation in some cases of auditory neuropathy can be a viable option.     

言语诱发听性脑干反应的潜伏期特性分析

目的探讨不同刺激强度下健康成人言语诱发听性脑干反应（speech evoked auditory brainstem response,speech-ABR）的潜伏期特性及其在脑干神经元编码言语信息中的意义。方法记录32例健康成人32耳在4种刺激强度（20、40、60、80dBSPL）、11.1次/s速率下的speech-ABR,分析不同强度条件下speech-ABR的潜伏期和相关性。结果 speech-ABR由一系列主波组成,分为起始部分（包括V和A波）、过渡部分（C波）、频率跟随部分（D-E-F波）和终止部分（O波）。随着强度的降低,各主波潜伏期逐渐延长,差异有统计学意义（P〈0.05）。强度降低20dBSPL级差时,潜伏期的平均延长值表现为V、A、C、O波接近,D、E、F波接近。不同强度下,V-A-C波潜伏期之间、D-E波潜伏期、E-F波潜伏期的相关性均有统计学意义,且相关系数大于0.40,其中V-A波潜伏期的相关系数大于0.80;强度降低时,潜伏期间的相关性有统计学意义的主波逐渐增多。结论健康成人speech-ABR各主波的潜伏期随着刺激强度降低而显著延长;起始反应和频率跟随反应的潜伏期及其显著相关性具有不同的变化特点。言语强度降低时,speech-ABR主波潜伏期的显著延长以及主波潜伏期间相关性的改变可能与言语的不易被识别有关。     

The progress of adrenoleukodystrophy as revealed by auditory brainstem evoked responses and brainstem histology

Summary Serial studies of auditory brainstem evoked responses (ABR) and slow vertex responses (SVR) were obtained during the progress of adrenoleukodystrophy in a 6-year-old boy. This child was normal until 5 years of age. His illness began with a gait disturbance, dysarthria, and hearing difficulty. Later, spastic paralysis, serious deafness, and blindness appeared. He died of respiratory failure 2 years after the onset.The ABR was normal at onset but changed to an abnormal pattern. Initially, there was lengthening of the wave V-I interpeak interval. This was followed by the disappearance of the later components as his general condition deteriorated. At the terminal stage, only a prolonged wave I was recordable. The postmortem pathology revealed demyelination of auditory nerves and remarkable neuronal loss in the auditory pathways of the brainstem; in addition, there was a variety of extensive degeneration throughout the cerebrum, in particular the complete degeneration of the white matter with secondarily occurring ganglionic cell changes. These data suggest that degeneration of the brainstem from rostral to caudal levels occurred.     

Otoacoustic emission, evoked potential, and behavioral auditory thresholds in the rhesus monkey (Macaca mulatta).

Distortion product otoacoustic emission (DPOAE), auditory brainstem evoked response (ABR), and behavioral thresholds were recorded in a group of 15 adult rhesus monkeys with normal auditory function. DPOAE thresholds were recorded with stimulus parameters selected to maximize signal-to-noise ratio. Additional averaging at the lowest frequencies ensured comparable noise levels across frequencies. DPOAE thresholds decreased with increasing frequency (f(2)=0.5-16 kHz) and at 16 kHz were close to 0 dB SPL. ABR thresholds were best from 1 through 16 kHz (32-38 dB peSPL); higher at 0.5 (45 dB peSPL), 24 (39 dB peSPL), and 30 kHz (49 dB peSPL). At all levels including threshold, the early ABR waves (II and I) were more prominent at the high frequencies while the later waves (IV and V) were more prominent at the low frequencies. The behavioral thresholds recorded were similar to those reported by other researchers although elevated by about 10 dB presumably because of the complexity of the threshold task. DPOAE and ABR thresholds can be reliably and efficiently recorded in the rhesus monkey and provide information concerning site of processing in the auditory pathway not directly available from behavioral data.