Interaction of click polarity, stimulus level, and repetition rate on the auditory brainstem response

The present study investigated the interaction of click polarity (compression, rarefaction, alternating), repetition rate (2.3 and 9.2 clicks per second), and stimulus level (60, 75, and 90 dB nHL) on auditory brainstem responses. Two tracings (trials) were obtained for each condition using 45 normally hearing subjects. Although no systematic Wave I, III, or V latency or amplitude differences were observed among polarities or repetition rates at the three intensities, statistically significant differences were observed for the following conditions: (1) Wave III latency at 90 dB nHL was longer for the 9.2 repetition rate than for the 2.3 rate, and latencies for compression clicks were shorter than rarefaction clicks; (2) Wave V latencies at 75 dB nHL were longer with compression clicks than with rarefaction clicks; (3) mean Wave V latencies at 60 and 75 dB nHL were slightly longer for the 2.3 click rate than for the 9.2 rate; and (4) Wave V amplitudes at 90 dB nHL were larger for rarefaction clicks than for compression clicks. Because latency and amplitude differences were small and only found in a few conditions, the results indicate that polarity is not a significant variable in normally hearing subjects when using slow repetition rates (less than or equal to 10 clicks per second) at moderate to high intensities (60 to 90 dB nHL). Because repetition rates of less than 10 clicks per second increases examination time but does not improve wave morphology, rates of 10 per second or faster are recommended for gathering normative data. Absolute amplitudes showed considerable intersubject variability, especially for Waves I and III. Intrasubject variability (test-retest) also was substantial. These findings suggest that absolute amplitudes may be of little use for distinguishing normal from pathologic populations.     

Effects of click duration of the latency of the early evoked response

The effect of click duration on the latency of waves I, III, and V was investigated by testing 20 normal-hearing subjects at 60 dB HL using electric pulses of 25, 50, 100, 200, and 400 microseconds. Alternating condensation and rarefaction clicks were used. The results revealed similar and nonsignificant latency differences for the 25-, 50-, and 100-microseconds pulses. However, the 100 microseconds duration is preferred to the 25-microseconds pulse because the latter reduced the maximum measurable hearing loss by about 13 dB. The results also showed that latencies increased approximately 0.10 ms as duration increased from 100 to 200 microseconds and by 0.20 ms when duration increased from 100 to 400 microseconds. Although such differences by themselves are small, they can combine with other stimulus or recording variables to be clinically significant. Therefore, it is important to control click duration when normative data are generated. A second experiment was conducted to assess the interaction of polarity (condensation, rarefaction, and alternating) and pulse duration (100 and 400 microseconds) on the wave V latency. These data revealed no latency differences among polarities at either duration.     

Comparison between auditory brain stem responses evoked by rarefaction and condensation step functions and clicks

In order to evaluate the influence of the trailing edge of clicks on the auditory brain stem response (ABR) in normal ears, rarefaction and condensation step functions (RS and CS) compared to rarefaction and condensation clicks (RC and CC) at an intensity of 70 dB nHL were used. Significant intraindividual differences could be found for the latencies and amplitudes in the RS-CS, RS-RC and RC-CC comparison. However, the mean values of the complete group of test subjects showed no significant differences for the latencies and amplitudes, except the significantly greater amplitudes of wave I and II for R versus C step and R versus C click. Only a tendency to shorter latency for wave VI with R versus C step and click was revealed. These results show that there was no essential influence of the trailing edge of the used R and C clicks on the ABR. The latency of the ABR with excitation of the cochlea by step or click function seemed to be mainly determined by the internal oscillation sequence in the cochlea and not by the stimulus polarity.     

The combined effects of forward masking by noise and high click rate on monaural and binaural human auditory nerve and brainstem potentials

OBJECTIVE: To study effects of forward masking and rapid stimulation on human monaurally- and binaurally-evoked brainstem potentials and suggest their relation to synaptic fatigue and recovery and to neuronal action potential refractoriness. METHODS: Auditory brainstem evoked potentials (ABEPs) were recorded from 12 normally- and symmetrically hearing adults, in response to each click (50 dB nHL, condensation and rarefaction) in a train of nine, with an inter-click interval of 11 ms, that followed a white noise burst of 100 ms duration (50 dB nHL). Sequences of white noise and click train were repeated at a rate of 2.89 s(-1). The interval between noise and first click in the train was 2, 11, 22, 44, 66 or 88 ms in different runs. ABEPs were averaged (8000 repetitions) using a dwell time of 25 micros/address/channel. The binaural interaction components (BICs) of ABEPs were derived and the single, centrally located equivalent dipoles of ABEP waves I and V and of the BIC major wave were estimated. RESULTS: The latencies of dipoles I and V of ABEP, their inter-dipole interval and the dipole magnitude of component V were significantly affected by the interval between noise and clicks and by the serial position of the click in the train. The latency and dipole magnitude of the major BIC component were significantly affected by the interval between noise and clicks. Interval from noise and the click's serial position in the train interacted to affect dipole V latency, dipole V magnitude, BIC latencies and the V-I inter-dipole latency difference. Most of the effects were fully apparent by the first few clicks in the train, and the trend (increase or decrease) was affected by the interval between noise and clicks. CONCLUSIONS: The changes in latency and magnitude of ABEP and BIC components with advancing position in the click train and the interactions of click position in the train with the intervals from noise indicate an interaction of fatigue and recovery, compatible with synaptic depletion and replenishing, respectively. With the 2 ms interval between noise and the first click in the train, neuronal action potential refractoriness may also be involved.     

Development of low-frequency tone burst versus the click auditory brainstem response

Often ABR threshold testing employs clicks to assess high-frequency hearing, and low-frequency tone bursts to assess low-frequency sensitivity. While a maturation effect has been shown for click stimuli, similar data are lacking for low-frequency toneburst stimuli. Thus, 305 infants ranging in conceptional age (CA) from 33 weeks to 74 weeks were tested. Absolute latencies were measured for wave V at 55, 35, and 25 dB nHL in response to a click and for wave V500 in response to a 500 Hz tone burst. Major wave latency in response to 500 Hz tone bursts decreases with age and do not stabilize by 70 weeks CA. Likewise, waves III and V latencies in response to clicks decrease with age, as has been reported by others, and do not stabilize by 70 weeks CA. Wave I latency produced by clicks did not decrease with age, being mature by 33 weeks CA.     

An analysis of auditory brainstem responses in infants

Acoustic brainstem responses (ABRs) were recorded from 148 infants from 4 to 60 weeks of age. 28 subjects returned to the laboratory 3 or more times for additional recordings. Filtered clicks of 1, 2, 4 and 8 kHz were presented at two intensities, 30 and 50 dB HL re the average threshold for a group of young adults. Responses to a broadband click, 50 dB nHL, were also recorded. The latencies of waves I, III and V were measured. Wave I latencies for the 8 kHz filtered click showed no change but those for lower frequencies decreased with age. The latency decreases with age were largest for wave V, and, among the filtered clicks, was largest for the responses to 1 kHz. Best-fitting curves were determined for latency vs. age for each filtered click and for the broadband click. Wave V —Wave I latency differences showed that the rostral conduction time for responses to the 8 kHz FC decreased with age and, for the 1 kHz filtered click (50 dB), remained constant. The early development of basal regions in the cochlea is viewed as insuring the delivery of a wide range of frequencies to rostral segments of the auditory system. The limiting feature of maturation is at rostral sites. The immature auditory system appears to be fully capable of transducing low frequency stimuli, but not high frequencies.     

Influence of stimulus polarity on far-field auditory-evoked electrical responses in the chick

The effects of inverting click phase on far-field peripheral and brainstem auditory-evoked responses (PBARs) were examined in 8 White Leghorn chicks of age 3 wks. Significant latency differences occurred in all major positive peaks (Pla, P2a peripheral; P3a central) in response to rarefaction vs condensation clicks of equal intensity, with condensation clicks producing the shortest latencies (latency differences: Pla = 0.374, P2a = 0.372 and P3a = 0.352 msec, p less than .001). The mean latency shift corresponds to an equivalent sine wave frequency of approximately 1360 c/s, a value close to the spectral peak energy of the click. No differences in interpeak latency values were found nor any significant amplitude effects.     

Effect of click spectrum and polarity on round window N1N2 response in the rat

The effect of the duration of click stimuli on the compound action potential recorded from the round window in the rat and the effect of low-pass filtering of short click sounds were studied. Thus the intensity functions of the round window N1 potential have a two-segment course and there is a difference in the response to rarefaction and condensation clicks, depending upon the content of low-frequency components in the click stimulus. The intensity function of the rat's response to broadband clicks does not show the same two-segment course as has been reported in experiments in other animals, and there is little difference between the response to condensation clicks and that to rarefaction clicks in this animal. However, when the duration of the click is increased or when broadband clicks are subjected to low-pass filtering, the intensity functions in response to condensation clicks do show a change in course, while the response to rarefaction clicks remains essentially unchanged. A similar change in the response to a broadband click can be induced by adding a low-pass-filtered click to the broadband click. The response to such a combination is not only a linear summation of the neural response to the individual components of the stimuli and the cochlear microphonics, but the low-frequency components that are added also affect the response to the broadband click, mainly by reducing the amplitude of the response.     

The choice of ABR click polarity and amplitude variables in multiple sclerosis patients.

Evoked brainstem responses (ABR) to 75 dB nHL condensation (C), rarefaction (R), and alternating (A = C+R) clicks were investigated in healthy subjects and in patients with multiple sclerosis. A new wave IV-V 'shape ratio' (SR IV-V) was most sensitive. SR IV-V correlated most strongly with clinical MS classification, and seemed to be rather specific for retrocochlear dysfunction. Wave IV-V amplitude was also more sensitive than the common IV-V amplitude ratio. The variability of latencies and interpeak latencies was lower in ABR to A clicks than in ABR to either R or to C clicks. In patients, fewer subcomponents were found in ABR to A than in ABR to R and C clicks. ABR to A clicks were on the average slightly more sensitive than either C or R click ABR. Our results suggest that both A-mode ABR and the 'dispersion' variable SR IV-V can be used without significant problems in the diagnosis of brainstem demyelination. A test protocol which requires ABR to both C and R clicks to be abnormal, will, however, be less sensitive, though probably more specific.     

Effect of high-frequency hearing loss on compound action potentials recorded from the intracranial portion of the human eighth nerve.

Compound action potentials (CAP) were recorded from the exposed intracranial portion of the eighth nerve to stimulation with click sounds in patients with sensorineural high-frequency hearing loss who underwent microvascular decompression (MVD) operations to treat trigeminal neuralgia (TN). In patients with normal hearing the CAP recorded in that way is characterized by a negative peak, preceded by a small positivity and followed by a positivity and sometimes a second negative peak. In patients with high-frequency hearing loss the CAP also usually had an initial sharp negative peak in response to clicks of high intensity (105 to 110 dB Pe SPL), similar to findings in patients with normal hearing, but in patients with high-frequency hearing loss the initial negative peak was often followed by a slow negative deflection. The latency of the initial negative peak in the CAP in patients with high-frequency hearing loss was longer than the latency of this peak in patients with normal hearing, but the difference in latencies of this peak to condensation and rarefaction clicks was small. When the stimulus intensity was lowered the amplitude of the initial peak decreased, and the CAP became dominated by a broad negative peak with a latency of 6 to 8 ms. In 11 of 15 patients with severe high-frequency hearing loss, a series of quasi-periodic waves was superimposed on the CAP. The frequency of these waves varied between 500 and 1200 Hz, and the waves could be detected between 6 and 16 ms after presentation of the click stimulus. These waves were usually present in the response to stimuli in the intensity range from 75 to 110 dB Pe SPL. Only 4 of 17 patients with normal hearing had similar waves.     

Effects of click polarity on ABR peak latency and morphology in a clinical population

Magnitude and direction of click phase-related shifts for ABR peaks I through V and the major interpeak intervals were measured for normal ears and ears with varying degrees of high frequency (HF) hearing loss. Latencies of Waves I and V were relatively stable with inversion of stimulus phase in ears with normal hearing and mild degrees of HF hearing loss, but the incidence of substantial phase-induced latency shifts increased in proportion to pure tone deficits. Waves II and IV demonstrated the greatest shifts in all hearing loss categories. Summation of dissimilar responses obtained with opposite acoustic polarities may result in response degradation. A number of phase-specific ABR abnormalities are discussed. In the greater proportion of ears, rarefaction clicks were the more productive stimulus in eliciting the full complement of response peaks.     

Auditory brainstem responses in dyslexia: comparison between acoustic click and verbal stimulus events

OBJECTIVES: This study examined the use of auditory brainstem response (ABR) by classic clicks and verbal stimuli in young dyslexic adults to identify latency abnormalities. METHODS: Subjects included 10 dyslexic adults and 10 age-, sex-, IQ-, education-, and hearing sensitivity-matched normal subjects. Both groups had normal auditory status. Measurements included the absolute latencies of waves I through V; the interpeak latencies I-III, III-V, and I-V elicited by acoustic click; and the negative peak latencies of A and B waves, as well as the interpeak latencies of A-B elicited by the verbal stimulus "ma," created on a digital speech synthesizer. RESULTS: The measured latencies and interpeak latencies in response to both clicks and verbal stimuli were found delayed in eight dyslexic subjects, although they did not reach the level of significant difference. However, two dyslexic subjects had significantly delayed peak and interpeak latencies elicited by verbal stimuli. CONCLUSIONS: There are dyslexic subjects who may have abnormalities in acoustic representation of a speech sound as low as the auditory brainstem, as elicited by the verbal stimulus "ma."     

Gender effects in auditory brainstem responses to air- and bone-conducted clicks in neonates.

Examinations of gender differences in auditory brainstem response (ABR) wave V latencies and thresholds to air- and bone-conducted clicks were undertaken with neonates. Two hundred and two full-term neonates participated (i.e., 103 males and 99 females). Wave V latency measures for air- and bone-conducted click stimuli of 30, 45, and 60 dB nHL and 15 and 30 dB nHL, respectively, and thresholds to air- and bone-conducted clicks were determined. Female newborns displayed statistically significant shorter wave V latencies than male newborns for air-conducted click stimuli (i.e., approximately 0.2-0.3 ms; P=.0016). There were no significant gender differences in wave V latencies to bone-conducted click stimuli (P=.11). With respect to ABR thresholds, no statistically significant differences were observed for either air-conducted clicks (P=.054) or bone-conducted clicks (P=.18). Educational objectives: As a result of this activity, the participant will be able to (1) describe gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates and (2) summarize possible explanations for observed gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates.     

Latencies of ABR (waves III and V) to binaural clicks: effects of interaural time and intensity differences

Auditory brainstem responses to monaural clicks and to binaural clicks delivered with interaural time differences of 0.5 and 1 ms (delayed clicks in left ear) and interaural intensity differences (right ear minus left ear) of 0, +/- 10, +/- 20, and +/- 30 dB were recorded bilaterally in 7 normal subjects. Latencies of wave III and wave V were studied as functions of click intensity difference for each of the two time-of-onset differences. As the intensity difference was gradually varied from +30 to -30 dB, the latencies were seen to shift (with constant III--V interval) from those of a monaural right-ear (non-delayed clicks) response to those of a monaural left-ear (delayed clicks) response by 0.5 and 1 ms. In all subjects this shift occurred in the 20-dB interval between equal intensity and 20-dB lagging-click dominance, and almost always most of the shift took place in either of the two 10-dB subintervals. Occasionally double-peaked waves appeared in the 20 dB-interval. Binaural ABRs may become useful for diagnosis in patients with signs of brainstem disorder but with normal-hearing and normal audiometric findings including monaural ABR, as such patients have been found to shift their latencies more slowly with varying interaural intensity difference.     

Brainstem Auditory Evoked Potentials in Patients With Ischemic Heart Disease

The authors of this study used the method of increased stimulus rate on brainstem auditory evoked potentials (BAEPs) in 30 patients with ischemic heart disease (IHD) and in an equal number of healthy age-matched control subjects. The BAEPs were recorded using 100- to 3000-Hz alternating polarity clicks at a rate of 22.6 per second. Measurements included the absolute latencies of waves I through V, the interpeak latencies I-III, III-V, and I-V, and the peak amplitudes of peaks I, III, and V. The measured absolute latencies and interpeak latencies were found to be significantly increased, and the peak amplitudes were found to be diminished. The audiometric tests revealed no significant hearing loss in IHD patients. This study is the first to demonstrate prolongation of BAEPs in IHD patients. BAEP recording may become an additional noninvasive tool for detecting IHD patients with impaired microcirculation.     

Investigation of the physiological basis of summating potential changes in endolymphatic hydrops

An increase in the ratio of the summating potential to the action potential components of the electrocochleogram is known to be a feature of endolymphatic hydrops. We investigated the value of the SP/AP ratio in response to condensation and rarefaction click stimuli delivered separately. In patients with electrophysiological evidence of endolymphatic hydrops there was found to be a significantly greater SP/AP ratio to condensation clicks than rarefaction clicks. This finding supports the hypothesis that the increased SP/AP ratio in hydrops is due to mechanical asymmetry of the basilar membrane.     

Brainstem auditory evoked potentials with the use of acoustic clicks and complex verbal sounds in young adults with learning disabilities

Purpose and background

Acoustic signals are transmitted through the external and middle ear mechanically to the cochlea where they are transduced into electrical impulse for further transmission via the auditory nerve. The auditory nerve encodes the acoustic sounds that are conveyed to the auditory brainstem. Multiple brainstem nuclei, the cochlea, the midbrain, the thalamus, and the cortex constitute the central auditory system. In clinical practice, auditory brainstem responses (ABRs) to simple stimuli such as click or tones are widely used. Recently, complex stimuli or complex auditory brain responses (cABRs), such as monosyllabic speech stimuli and music, are being used as a tool to study the brainstem processing of speech sounds. We have used the classic ‘click’ as well as, for the first time, the artificial successive complex stimuli ‘ba’, which constitutes the Greek word ‘baba’ corresponding to the English ‘daddy’.

Patients and methods

Twenty young adults institutionally diagnosed as dyslexic (10 subjects) or light dyslexic (10 subjects) comprised the diseased group. Twenty sex-, age-, education-, hearing sensitivity-, and IQ-matched normal subjects comprised the control group. Measurements included the absolute latencies of waves I through V, the interpeak latencies elicited by the classical acoustic click, the negative peak latencies of A and C waves, as well as the interpeak latencies of A–C elicited by the verbal stimulus ‘baba’ created on a digital speech synthesizer.

Results

The absolute peak latencies of waves I, III, and V in response to monoaural rarefaction clicks as well as the interpeak latencies I–III, III–V, and I–V in the dyslexic subjects, although increased in comparison with normal subjects, did not reach the level of a significant difference (p < 0.05). However, the absolute peak latencies of the negative wave C and the interpeak latencies of A–C elicited by verbal stimuli were found to be increased in the dyslexic group in comparison with the control group (p = 0.0004 and p = 0.045, respectively). In the subgroup consisting of 10 patients suffering from ‘other learning disabilities’ and who were characterized as with ‘light’ dyslexia according to dyslexia tests, no significant delays were found in peak latencies A and C and interpeak latencies A–C in comparison with the control group.

Conclusions

Acoustic representation of a speech sound and, in particular, the disyllabic word ‘baba’ was found to be abnormal, as low as the auditory brainstem. Because ABRs mature in early life, this can help to identify subjects with acoustically based learning problems and apply early intervention, rehabilitation, and treatment. Further studies and more experience with more patients and pathological conditions such as plasticity of the auditory system, cochlear implants, hearing aids, presbycusis, or acoustic neuropathy are necessary until this type of testing is ready for clinical application.     

Statistical properties of ABR amplitudes and latencies. Implications for computation of reference limits and relation to click phase

A method for statistical analysis and computation of reference limits for ABR latency and amplitude variables is presented. Condensation and rarefaction ABRs from 47 healthy controls aged 4-58 years were investigated. With respect to gaussianity of distributions, the square root transformation was superior to the logarithmic transformation for amplitudes, while the logarithmic transformation performed better for amplitude ratios. Wave V latency and the I-V interpeak latency were nearly normally distributed, while other latencies and inter-peak latencies displayed varying displacement from a normal distribution. Rarefaction ABR distributions were slightly closer to normality than were condensation ABRs. Amplitude vs. following amplitude and latency vs. amplitude correlation coefficients were larger for R than for C click ABRs; thus R clicks seem to evoke a better synchronized neural volley. Most of the correlation between amplitude and latency could be explained by the influence of age and sex. Hence, age and sex matched reference limits for ABR amplitudes, without correction for latency, seem to be adequate in practical clinical work.     

The normative basis for click and frequency-specific BERA in high-risk infants

The use of brainstem electric response audiometry (BERA) for early detection of hearing loss is predicated upon large-sample normative data. Auditory brainstem response (ABR) thresholds for click and notch-masked tonepip stimuli were examined in 230 normal infants with no risk factors for hearing loss, tested under audiometrically ideal conditions at between 48 and 56 weeks post-conception. The ABR threshold distributions for clicks and tonepips differed considerably. Almost all infants had click thresholds consistent with normal hearing on adult criteria, whereas many appeared to have hearing loss at 500 Hz. ABR latencies for 70 dBnHL clicks were more variable than expected, even in infants with click thresholds of 30 dB or better. In males, wave V latency was about 0.2 ms larger than in females, but there was no such difference for wave I. For both sexes, there was a linear decrease in wave V latency with age at approximately 0.1 ms per month, but wave I latency was constant.     

Auditory brainstem response in pediatric migraine: during the attack and asymptomatic period

OBJECTIVE: The aim of this study was to evaluate the hearing parameters of children with migraine during ictal and interictal period. METHOD: 16 pediatric patients with migraine and normal otolaryngologic examination were evaluated. Hearing parameters were assessed with auditory brainstem response (ABR) testing between and during the migraine attacks. Binaural absolute latencies of waves I, III and V, interpeak latencies I-III, III-V and I-V of ABR in response to 80 dB nHL clicks were calculated. Initial findings were compared with those of 20 healthy volunteers. RESULTS: Peak latencies of wave V and interpeak latencies of I-V were prolonged during the attack in migraineurs on the left. The side of latency elongation was not affected by the side of headache. When these parameters were separately compared for gender, they were prolonged in boys during the attack in migraineurs; however in girls, while there was statistically significant difference at interpeak latencies of I-V, no significant difference was noted at peak latencies of wave V. CONCLUSIONS: ABR waves did not exceed clinical norms in migraine patients in headache-free period. But, important effects on sensorineural hearing parameters were detected during the attack. Our results indicated a transient impairment of the auditory brainstem function during the headache in pediatric migraine patients.