bic presentation coco
DESCRIPTION
Binaural Interaction Component of the ABR in Veterans with Type II DiabetesTRANSCRIPT
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Binaural Interaction Component of the ABR in Veterans with Type 2 Diabetes
Laura Coco, B.A.1,2, Marilyn Dille, Ph.D.2, Garnett P. McMillan, Ph.D.2, Dawn Konrad-Martin, Ph.D. 2
(1) University of Texas at Austin, Austin TX (2) National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland OR
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• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications • retinopathy• nephropathy• numbness in limbs• ataxia
Introduction
WHO, 2010; Austin et al 2009; Vaughn et al 2006; Miller et al 2004
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• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Diaz de Leon-Morales et al., 2005; Frisina et al., 2006; Vaughn et al., 2006; Bainbridge et al.,
2008; Austin et al., 2009; Cheng et al., 2009; Mitchell et al., 2009; Bainbridge et al., 2011; Bamanie and Al-Noury, 2011; Lerman-Garber et al., 2012)
Introduction
Bainbridge 2008
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• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Bainbridge et al. 2008; Dalton et al. 1998; Agrawal et al. 2009; Cullen & Cinnamond 1993; Lisowska et al. 2001, Frisina
et al. 2006; Vaughan et al. 2007; Austin et al. 2009)
• Central (Parving et al., 1990; Bayazit et al., 2000; Durmus et al., 2004; Diaz de Leon-Morales et al., 2005; Vaughn et al., 2007; Konrad-Martin et al., 2010)
Introduction
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• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Bainbridge et al. 2008; Dalton et al. 1998; Agrawal et al. 2009; Cullen & Cinnamond 1993; Lisowska et al. 2001, Frisina et al.
2006; Vaughan et al. 2007; Austin et al. 2009)
• Central (Diaz de Leon-Morales et al 2005; Vaughan et al 2007; Bayazit et al 2000; Konrad-Martin et al 2010)
Introduction
Konrad-Martin et al 2010
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• Poor performance on speech in noise tasks
Diabetes and Hearing
Frisina et al 2006
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• Sound localization• Separating noise from speech• Loudness summation• Redundancy/Comparison• Squelch
Binaural Hearing
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How do we evaluate binaural hearing?
Behavioral tests: SSI, HINT, SPIN, WIN, DDT, MLD, SCAN
Electrophysiological tests: N1P2 speech in noise
Binaural Hearing
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Binaural Hearing
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Binaural HearingAuditory Brainstem Response
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Binaural Hearing
Wave I/II Wave III
Wave V
Auditory Brainstem Response
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Normal: (L+R) > BIN
Binaural Interaction ComponentThe difference between the sum of the two Monaural ABRs and the Binaural ABR
Fowler & Broadard 1988
LeftRight
Binaural (BIN)Left + Right
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Binaural Interaction ComponentThe difference between the sum of the two Monaural ABRs and the Binaural ABR
Abnormal: (L+R) = BIN • Neural disorders
• CAPD
• animal model with intentional lesion
1. Fowler 20022. Delb 2003; Gopal & Pierel 19993. Wada & Starr 1989; Gardi & Berlin 1981
abnormalnormal
L + R
BIN
I II III IV V I II III IV V
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Binaural Interaction Component
Disappears at ILD >16dB and ITD> 1.6msec
Behavioral tests show that Binaural Interaction disappears when signal is no longer intracranially fused
Furst 1985, McPherson & Starr 1995
The BIC correlates well with psychophysical measures of binaural processes
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Binaural Interaction ComponentHow to measure
1. “Difference Waveform”
2. “BIC Amplitude”
3. “BIC Ratio”
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Difference Waveform
Control
Abnormal
Binaural Interaction ComponentHow to measure
Fowler 1988
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Binaural Interaction ComponentHow to measure
BIC Amplitude = Monaural Aggregate – Binaural response Values closer to zero indicate smaller Binaural Interaction.
Gopal et al 1998
Wave V amplitude (µV) Controls CAPDMonaural Aggregate (L+R) 1.32 0.98BIN 0.91 0.89BIC Amplitude= (L+R)-BIN 0.41 0.09
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Binaural Interaction Component
BIC Ratio = Binaural response ÷ Monaural AggregateValues closer to one indicate smaller Binaural Interaction.
How to measure
Gopal et al 1998
Wave V amplitude (µV) Controls CAPDMonaural Aggregate (L+R) 1.32 0.98BIN 0.91 0.89BIC Amplitude= (L+R)-BIN 0.41 0.09BIC Ratio BIN/L+R 0.69 0.91
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Research Question
Do Veterans with DM have a decreased BIC of the ABR when compared to Veterans without the disease?
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Methods• ABR obtained and scored from 81 subjects
As part of a larger Longitundal study on Diabetes and Hearing Loss
• Subset of 47 subjects met inclusion criteria
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Methods• ABR obtained from 81 subjects
As part of a larger Longitundal study on Diabetes and Hearing Loss
• Subset of 47 subjects based on inclusion criteria
• Wave V was initially selected with an automated algorithm based on criteria set for a predicted latency window (5.6 – 6.5 ms.)
• Double scored by experienced examiners
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MethodsWave I Wave II Wave III Wave V
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Control Subject DM Subject
ResultsDifference waveform
L+R
BIN
BIC
L+R
BIN
BIC
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Results
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Results
Left 0.63Right 0.62
x axis Monaural Aggregate (L+R) 1.25y axis Binaural 0.78
Wave V Peak-baseline amplitude (µv) for one control subject (marked as blue star)
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Results
Values closer to zero indicate smaller Binaural Interaction.
BIC Amplitude
ControlWeihing 2008 controls
T2DMGopal & Pierel 1999 CAPD
(n=24) (n=15) (n=23) (n=9)
0.210 0.180 0.156 0.089 0.39
Table 2. Raw mean BIC Amplitude results (µV) by Diabetes status.
BIC Amplitude (L + R) - BIN
P-value
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Results
Values closer to zero indicate smaller Binaural Interaction.
BIC Amplitude
Control T2DM(n=24) (n=23)
0.210 0.156
BIC Amplitude (L + R) - BIN
Table 2. Raw mean BIC Amplitude results (µV) by Diabetes status.
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Results
Values closer to one indicate smaller Binaural Interaction.
BIC Ratio
ControlWeihing 2008 controls
T2DMGopal & Pierel 1999 CAPD
(n=24) (n=15) (n=23) (n=9)
0.725 0.876 0.788 0.909 0.57
Table 3. Raw mean BIC Ratio results by Diabetes status.
P-valueBIC Ratio BIN/L+R
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Results
Values closer to one indicate smaller Binaural Interaction.
BIC Ratio
Control T2DM(n=24) (n=23)
0.725 0.788
BIC Ratio BIN/L+R
Table 3. Raw mean BIC Ratio results by Diabetes status.
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Results
P value= .7439AIC: -45.6
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Discussion• Different ways to measure Binaural Interaction
Contributions:
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Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
Contributions:
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Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
• Curved line is the best fit to describe Binaural Interaction
Contributions:
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Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
• Curved line is the best fit to describe Binaural Interaction
• Benefits to regression model
Contributions:
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DiscussionFuture direction:
• Longitudinal study • Compare to gold standard, ROC analysis• BIC of MLR & LLR• BIC-focused study that varies parameters
• BIC threshold• Use in impaired populations
• Blast subjects• Other BIC applications
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Thank youDawn Konrad-MartinMarilyn DilleGarnett McMillanJane Gordon Dan McDermottNCRAR StaffSara Sell
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