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Auditory Steady State Responses (ASSRs): Pros and Cons for Clinical Use

Auditory Steady State Responses (ASSRs): Pros and Cons for Clinical Use. Advantages (Pros) Reasonably frequency specific stimuli Can be used for electrophysiological assessment of severe to profound degree of hearing loss in infants and young children FDA-approved clinical devices available

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Auditory Steady State Responses (ASSRs): Pros and Cons for Clinical Use

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  1. Auditory Steady State Responses (ASSRs):Pros and Cons for Clinical Use • Advantages (Pros) • Reasonably frequency specific stimuli • Can be used for electrophysiological assessment of severe to profound degree of hearing loss in infants and young children • FDA-approved clinical devices available • Automated analysis • Potential disadvantages (Cons) • Requires very quiet state of arousal • Sedation or anesthesia is often necessary • Limited anatomic site specificity • Analysis difficult with bone conduction stimulation

  2. Estimation of Frequency-Specific Auditory Thresholds for Infants with in Severe-to-Profound Hearing Loss: An Important Application of ASSR

  3. ASSR Permits Early, Objective, and Confident Diagnosis of Candidates for Cochlear Implants

  4. Auditory Steady State Response (ASSR):NewInvestigations and New Applications(> 600 Peer Reviewed Publications) • Venail et al (2014). Refining the audiological assessment in children using narrow-band CE-chirp-evoked steady state responses. Int J Audiol, 18, 1-8 (France) • Rampp et al (2014). Viability of intraoperative auditory steady state responses during intracranial surgery. J Clin Neurophysiol, 31, 344-351 (Germany) • Hatzopoulos et al (2012). Hearing threshold prediction with ASSRs and estimation of correction functions to compensate for differences with behavioral data in adult subjects: Part 1: Audera and CHARTR EP devices. Med Sci Monit, 18, 47-53 • Drouillard et al (2014). Pseudohypacusis in children: Circumstances and diagnostic strategy. Int Pedi ORL, Epub

  5. Update on Auditory Electrophysiology • Introduction to auditory electrophysiology … 85-years of research and clinical application • Electrocochleography (ECochG) … Much more than just the diagnosis of Meniere’s Disease • ABR … Over 4000 peer-reviewed publications in the past decade alone • ASSR … Filling an important niche in children and adults • Cortical auditory evoked responses … Now we’re really assessing hearing • Summary, Questions & Answers

  6. Cortical Auditory Evoked Responses:Objective Measures of Central Auditory System Function P300ALRAMLRABRECochG

  7. Dan Geisler, Ph.D.Discoverer of Auditory Middle Latency Response (AMLR) in 1958 Geisler, C. D., Frishkopf, L. S., & Rosenblith, W. A. (1958). Extracranial responses to acoustic clicks in man. Science, 128, 1210-1211. Cody, D. T. R., Jacobson, J. L., Walker, J. C., & Bickford, R. G. (1964). Averaged evoked myogenic and cortical potentials to sound in man. Annals of Otology, Rhinology, and Laryngology, 73, 763-777.

  8. Auditory Middle Latency Response (AMLR):Analysis Pa (22 - 30 ms) Pb 1 mV Na Nb Amplitude (mV) PAM PAM = Post-auricular muscle 100 ms

  9. Origins of the Auditory Middle Latency Response (AMLR)(Photograph adapted from F.E. Musiek) PrimaryAuditoryCortex PrimaryAuditoryCortex Thalamus(MedialGeniculateBody) Thalamus(MedialGeniculateBody)

  10. Right Hemisphere C6 Left Hemisphere C5 Abnormal Patterns of AMLR with Right Hemisphere LesionElectrode Effect Pa Pb V V RE RE Na Na LE LE Right Ear Left Ear

  11. Sensitivity and Specificity of the AMLR in the Detection of Auditory CNS Dysfunction • Musiek F, Charette L, Kelly T, Lee WW, Musiek R. Hit and false-positive rates for middle latency response in patients with central nervous system involvement. JAAA 10: 1999. • 26 adult control subjects and 26 patients with medically confirmed CANS lesions (mostly CVAs and lobectomies) • Two groups matched for hearing status and age • AMLR measured with hemispheric electrode array (C3 and C4) • Latency measured for Na and Pa • Amplitude measured for Na-Pa • ROC curves generated by plotting hit rate by the false-positive rate for different criteria, e.g., absolute latency and amplitude, and differences in these parameters for ipsi versus contra AMLRs

  12. AMLR Component (Amplitude in V) • Hemisphere Na-Pa Na Pa • Side of Lesion • Mean 0.55 0.20 0.35 • (SD) (0.20) (0.14) (0.24) • Intact Side • Mean 0.86 0.28 0.63 • SD (0.21) (0. 15) (0.27) Abnormal Patterns for Auditory Middle Latency Response (AMLR)in Patients with Confirmed Temporal Lobe Lesions(Musiek et al, 2007)

  13. Ear and Electrode Effects in Pediatric Auditory Middle Latency Response (AMLR) Recordings • Weihling J, Schochat E & Musiek F. (2013) Ear and electrode effects reduce within-group variabiliy in middle latency response amplitude measures. International Journal of Audiology, 51, 405-412 • 155 children • Normal peripheral function • Normal central auditory function • No history of psychological, neurological, or learning disorders • Na-Pa amplitude differences were measured for • AMLR C3 – C4 hemispheric electrode recording sites • Left ear – right ear stimulation • Conclusions • Within group variability was significant smaller for relative differences when compared to absolute measures • Electrode effects showed significantly less variability than ear effects • Authors reports normative data

  14. Normal Expectations for Electrode Effects in Pediatric Auditory Middle Latency Response (AMLR) Recordings(Weihling, Schochat & Musiek, 2013)

  15. Normal Expectations for Ear Effects in Pediatric Auditory Middle Latency Response (AMLR) Recordings(Weihling, Schochat & Musiek, 2013)

  16. Documenting Benefits of Auditory Training with Auditory Middle Latency Response (AMLR) Responses • Schochat E, Musiek FE, Alonso R & Ogata J (2010). Effect of auditory training on the middle latency response in children with (central) auditory disorder. Brazilian Journal of Medical and Biological Research, 43, 777-785 • Subjects • 30 children (age 8 – 14 years) with APD • 22 children without APD • Diagnosis of APD • Pediatric speech intelligibility (PSI) test • Speech-in-noise test • Dichotic digits test • Dichotic non-verbal test

  17. Documenting Benefits of Auditory Training with Auditory Middle Latency Response (AMLR) Responses (2) • Schochat E, Musiek FE, Alonso R & Ogata J (2010). Effect of auditory training on the middle latency response in children with (central) auditory disorder. Brazilian Journal of Medical and Biological Resarch, 43, 777-785 • Auditory training protocol • Frequency discrimination training • Intensity discrimination training • Temporal (duration) discrimination training • Dichotic Inter-aural Intensity Difference (DIID

  18. Documenting Benefits of Auditory Training with Auditory Middle Latency Response (AMLR) Responses (3) • Schochat E, Musiek FE, Alonso R & Ogata J (2010). Effect of auditory training on the middle latency response in children with (central) auditory disorder. Brazilian Journal of Medical and Biological Resarch, 43, 777-785 • Pre-training click-evoked AMLR C3-A1 Na-Pa amplitudes were smaller in the APD group • 0.84 uV for APD group • 1.18 uV for control group • 8 week period of auditory training for APD group only • Post-training AMLR C3-A1 Na-Pa amplitudes increased significantly to 1.59 uV in the APD group

  19. Documenting Benefits of Auditory Training with Auditory Middle Latency Response (AMLR) Responses(Schochat E, Musiek FE, Alonso R & Ogata J, 2010)

  20. Hallowell Davis, Ph.D. “Father of Auditory Evoked Responses” Co-Discoverer of ALR in 1939 and P300 Response in 1965 Davis, H., Davis, P. A., Loomis, A. L., Harvey, E. N., & Hobart, G. (1939). Electrical reactions of the human brain to auditory stimulation during sleep. Journal of Neurophysiology, 2, 500-514

  21. Auditory Late Response (Cortical) 5mV P2 (180 – 200 ms) P1 (50 ms) Amplitude (mV) N2 (200 - 400 ms) N1 (90 - 150 ms) 600 ms Stimulus

  22. P300 Response:Classic Oddball Paradigm P2 FrequentUnattendede.g., 1000 Hz or /da/ P3 (300)* P2 Amplitude (mV) Infrequent (rare)Attendede.g., 2000 Hz or /ga/ 500 ms * P3b

  23. Auditory LateResponse: Generators P300N2P2N1

  24. Clinical Applications of Auditory Late Response(> 7000 Peer Reviewed Publications for “CAEP”) • Objective documentation of cortical auditory dysfunction in diverse clinical populations, e.g., • Auditory processing, language, and reading disorders • Traumatic brain injury • Neurological and neuropsychiatric disorders • Objective assessment of hearing thresholds in suspected false or exaggerated hearing loss, especially adults seeking compensation • Documentation of benefits of intervention in infants and young children, e.g., • Amplification • Cochlear implants

  25. Clinical Applications of Auditory Late Response(Anu Sharma, PhD, University of Colorado) • Cardon G, Campbell J and Sharma A (2012). Plasticity in the developing auditory cortex: Evidence from children with sensorineural hearing loss and Auditory Neuropathy Spectrum Disorder. Journal of the America Academy of Audiology • Sharma, A, Cardon G, Henion K and Roland P (2011). Cortical maturation and behavioral outcomes in children with auditory neuropathy spectrum disorder. International Journal of Audiology,50, 98-106 • Sharma, A, Nash A, and Dorman A (2009) Cortical development, plasticity and reorganization in children with cochlear implants. Journal Communication Disorders, 42, 272 • Gilley PM, Sharma A, Dorman M and Martin K. (2006) Abnormalities in central auditory maturation in children with language based learning disabilities. Clinical Neurophysiology, 117, 1949

  26. Clinical Applications of Auditory Late Response:Hearing Aid versus Cochlear Implant Performance(Anu Sharma, PhD, University of Colorado)

  27. Clinical Applications of Auditory Late Response:Documenting Cortical Maturation(Anu Sharma, PhD, University of Colorado)

  28. Clinical Applications of Auditory Late Response:Documenting Hearing Aid Performance(Anu Sharma, PhD, University of Colorado)

  29. Clinical Applications of Auditory Late Response:Hearing Aid versus Cochlear Implant Performance(Anu Sharma, PhD, University of Colorado)

  30. Clinical Applications of Auditory Late Response:Cochlear Implant Performance(Anu Sharma, PhD, University of Colorado)

  31. Clinical Assessment of APD with the ALR: How Can We Make it Happen? • Accepted evidence-based test protocol • Clinical instrumentation with new features (ALR options), e.g., • Multiple channels for hemisphere and eye blink electrodes • Speech stimuli available within ALR protocols • APD protocols for measurement of ALR, e.g., • Speech-in-noise • Dichotic stimuli • Temporal processing (gap detection) • Statistical analysis of ALR parameters, e.g., • Latency • Amplitude and amplitude under the curve • Normative data (collected with clinical instrumentation) • Maturational data on ALR • Latency and amplitude data for various stimuli

  32. Auditory Event-Related Potentials to Words: Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine FitzharrisPlural Publishing, 2014

  33. Auditory Event-Related Potentials to Words: Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine FitzharrisPlural Publishing, in press Listening Task = Repeating the word that is heard

  34. Digital Version in 2015 Thank You!Questions? Pearson, 2014

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