iapa summer school 2008 neonatal hearing screening and auditory neuropathy berlin, germany april...
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IAPA Summer School 2008 Neonatal Hearing Screening and
Auditory Neuropathy Berlin, Germany
April 10th and 11th
UPDATING THE UPDATING THE ELECTROPHYSIOLOGY IN ELECTROPHYSIOLOGY IN
NEONATAL HEARING NEONATAL HEARING EVALUATIONEVALUATION
José J. Barajas de José J. Barajas de PratPrat
WHAT SHOULD THE IDEAL INFANT HEARING WHAT SHOULD THE IDEAL INFANT HEARING ASSESSMENT?ASSESSMENT?
Must be applicable to neonates and Must be applicable to neonates and childrenchildren
Measure Hearing sensitivity from Measure Hearing sensitivity from 250-8 kHz250-8 kHz
Assess hearing sensitivity for mild to Assess hearing sensitivity for mild to severe- profound hearing losssevere- profound hearing loss
Objectively detect an infant´s Objectively detect an infant´s response to soundresponse to sound
ELECTROPHYSIOLOGIC TECHNIQUESELECTROPHYSIOLOGIC TECHNIQUES
Click and tone- burst evoked ABRClick and tone- burst evoked ABR Evoked potentials for tones that are Evoked potentials for tones that are
amplitude and/or frequency amplitude and/or frequency modulatedmodulated Auditory-steady state responses (ASSR)Auditory-steady state responses (ASSR)
AMLR and 40 Hz AMLR and 40 Hz Cortical AEPsCortical AEPs
LIMITATIONS OF CONVENTIONAL EVOKED LIMITATIONS OF CONVENTIONAL EVOKED POTENTIAL TESTSPOTENTIAL TESTS
Click ABR:Click ABR: Cannot be used to estimate the 4 frequency Cannot be used to estimate the 4 frequency
(500-4000 Hz) audiogram(500-4000 Hz) audiogram TB-ABR:TB-ABR:
Lenghtly procedure, relies on subjective Lenghtly procedure, relies on subjective analysis of waveformsanalysis of waveforms
AMLR, 40 Hz and CAEP:AMLR, 40 Hz and CAEP: Unreliable during natural or sedated sleep on Unreliable during natural or sedated sleep on
infants and childreninfants and children CAEP methods with quietly awake infants may CAEP methods with quietly awake infants may
hold promise for estimates of thresholds and hold promise for estimates of thresholds and speech feature discrimination abilitiesspeech feature discrimination abilities
AUDITORY STEADY STATE RESPONSE (ASSR)AUDITORY STEADY STATE RESPONSE (ASSR)
Can be recorded in neonates and Can be recorded in neonates and childrenchildren
Are evoked by frequency –specific Are evoked by frequency –specific tonal stimulitonal stimuli
Correlate with elevation in the Correlate with elevation in the hearing thresholdshearing thresholds
Can be objectively evaluatedCan be objectively evaluated Are used to estimate an audiogramAre used to estimate an audiogram
Jose J. Barajas. (1985). Auditory Brainstem and Middle Latency Jose J. Barajas. (1985). Auditory Brainstem and Middle Latency Response in Early Detection of Hearing Loss in Infants. New Response in Early Detection of Hearing Loss in Infants. New dimensions in otorhinolaryngology – head and neck surgery (1); pp dimensions in otorhinolaryngology – head and neck surgery (1); pp 289-292.289-292.
40 Hz40 Hz
Jose J. Barajas. (1988). Middle Latency and 40 Hz Auditory Evoked Jose J. Barajas. (1988). Middle Latency and 40 Hz Auditory Evoked Responses in normal hearing children: 500 Hz thresholds.Scand Audiol Responses in normal hearing children: 500 Hz thresholds.Scand Audiol Supp 30:99-104Supp 30:99-104
Picton TW, John MS, Dimitrijevic A, Purcell D. Human auditory Picton TW, John MS, Dimitrijevic A, Purcell D. Human auditory steady-state responses. Int J Audiol. 2003 Jun;42(4):177-219.steady-state responses. Int J Audiol. 2003 Jun;42(4):177-219.
MEASUREMENTS OF SIGNAL AND NOISE AT MEASUREMENTS OF SIGNAL AND NOISE AT DIFFERENT RATESDIFFERENT RATES
UPDATING THE ELECTROPHYSIOLOGY IN UPDATING THE ELECTROPHYSIOLOGY IN NEONATAL HEARING NEONATAL HEARING
ASSR in newbornsASSR in newborns AEP and early hearing aid fitting and AEP and early hearing aid fitting and
validation validation ASSRASSR CAEP (Obligatory Cortical Auditory Evoked CAEP (Obligatory Cortical Auditory Evoked
Potentials)Potentials)
AEP: Cochlear Implants validationAEP: Cochlear Implants validation
ASSR IN NEWBORNSASSR IN NEWBORNS
ASSR characteristics in newborns:ASSR characteristics in newborns: The neonatal ASSRThe neonatal ASSR Amplitude Development in InfantsAmplitude Development in Infants Detection of ASSR in the neonatal Detection of ASSR in the neonatal
infant periodinfant period ASSR threshold in babiesASSR threshold in babies
THE NEONATAL ASSRTHE NEONATAL ASSRAVERAGED AMPLITUDE FOR NORMAL- HEARING AVERAGED AMPLITUDE FOR NORMAL- HEARING
INFANTS AND ADULTSINFANTS AND ADULTS
Luts H, Desloovere C, Wouters J.2006. Clinical application of dichotic Luts H, Desloovere C, Wouters J.2006. Clinical application of dichotic multiple-stimulus auditory steady-state responses in high-risk newborns multiple-stimulus auditory steady-state responses in high-risk newborns and young children. Audiol Neurootol.;11(1):24-37. and young children. Audiol Neurootol.;11(1):24-37.
AMPLITUDE DEVELOPMENTAMPLITUDE DEVELOPMENT
Johns MS, Brown DK, Muir PJ, Picton TW (2004) . Recording Auditory Johns MS, Brown DK, Muir PJ, Picton TW (2004) . Recording Auditory Steady State responses in young infants. Ear Hear Dec, 25 (6) 539-53. Steady State responses in young infants. Ear Hear Dec, 25 (6) 539-53.
DETECTION OF ASSR IN THE NEWBORNDETECTION OF ASSR IN THE NEWBORN
Is determine by:Is determine by: Amplitude of the response:Amplitude of the response:
Stimulus typeStimulus type Modulation rateModulation rate Carrier frequencyCarrier frequency Electrode configurationElectrode configuration
Amplitude of the background noise:Amplitude of the background noise: State of arousalState of arousal EEG frequency rangeEEG frequency range Test durationTest duration
OPTIMAL MODULATION RATE FOR EACH OPTIMAL MODULATION RATE FOR EACH CARRIERCARRIER
Rickards FW, Tan LE, Cohen LT, Wilson OJ, Drew JH, Clark GM. (1994). Rickards FW, Tan LE, Cohen LT, Wilson OJ, Drew JH, Clark GM. (1994). Auditory steady-state evoked potential in newborns. Br J Auditory steady-state evoked potential in newborns. Br J Audiol.;28(6):327-37. Audiol.;28(6):327-37.
500 Hz
1500 Hz
4000 Hz
ASSR THRESHOLDS IN BABIESASSR THRESHOLDS IN BABIES
Threshold values Threshold values Threshold changes in infancyThreshold changes in infancy Development mechanism affecting Development mechanism affecting
ASSRASSR ASSR vs Tone burst ABR in neonatesASSR vs Tone burst ABR in neonates
ASSR THRESHOLD IN BABIESASSR THRESHOLD IN BABIES
Luts, H. “Diagnosis of Hearing Loss in Newborns. Clinical Application Luts, H. “Diagnosis of Hearing Loss in Newborns. Clinical Application of Auditory Steady- State responses”. Director: Prof. Dr. J. Wouters . of Auditory Steady- State responses”. Director: Prof. Dr. J. Wouters . Katholieke Universiteit Leuven, Faculty of Medicine, 2005Katholieke Universiteit Leuven, Faculty of Medicine, 2005
ASSR THRESHOLD CHANGES IN INFANCYASSR THRESHOLD CHANGES IN INFANCY
Rance, G. & Tomlin, D. (2006). Maturation of ASSR in nomal Rance, G. & Tomlin, D. (2006). Maturation of ASSR in nomal babies. Ear & Hearing, 27, 20-29.babies. Ear & Hearing, 27, 20-29.
Rance G, Tomlin D. (2006). Maturation of auditory steady-state Rance G, Tomlin D. (2006). Maturation of auditory steady-state responses in normal babies. Ear Hear.;27(1):20-9.responses in normal babies. Ear Hear.;27(1):20-9.
DEVELOPMENTAL MECHANISMS AFFECTING DEVELOPMENTAL MECHANISMS AFFECTING ASSR THRESHOLD IN INFANCYASSR THRESHOLD IN INFANCY
ASSR & TONE-BURST ABRs IN NEONATESASSR & TONE-BURST ABRs IN NEONATES
Rance G (2008). Assr in Neonates & Infants. In Auditory Steady-Rance G (2008). Assr in Neonates & Infants. In Auditory Steady-State ResponseState Response
Generation, Recording, and Clinical Applications. Gary Rance Generation, Recording, and Clinical Applications. Gary Rance
HEARING LEVEL PREDICTIONHEARING LEVEL PREDICTION
Sensation levelSensation level Regresion formula describing ASS Regresion formula describing ASS
behavioral regressionbehavioral regression
ASSRs IN HEARING IMPAIRED BABIESASSRs IN HEARING IMPAIRED BABIES
Rance G (2008). ASSR in Neonates & Infants. In The Auditory Rance G (2008). ASSR in Neonates & Infants. In The Auditory Steady-State Response: Generation, Recording, and Clinical Steady-State Response: Generation, Recording, and Clinical Applications. Edited by Gary Rance. In review. Applications. Edited by Gary Rance. In review.
For older children and adult subjects For older children and adult subjects ASSR/behavioral threshold ASSR/behavioral threshold correlation has been empirically correlation has been empirically establishedestablished
In normally developing babies this In normally developing babies this relationship is NOT well defined. relationship is NOT well defined.
ASSR threshold variance in babies is ASSR threshold variance in babies is higher than for adults (> 30 dB)higher than for adults (> 30 dB) Ear canal differences.Ear canal differences. Neural development.Neural development.
HEARING LEVEL PREDICTIONHEARING LEVEL PREDICTION
CONCLUSIONCONCLUSION
Maturation factors affect ASSR.Maturation factors affect ASSR. Normally hearing babies present Normally hearing babies present
lower amplitudes than adults and lower amplitudes than adults and older children.older children.
Neonatal period threshold higher and Neonatal period threshold higher and more variable.more variable.
Need to determine typical response Need to determine typical response levels for babies of different ages and levels for babies of different ages and developmental stages. developmental stages.
UPDATING THE ELECTROPHYSIOLOGY IN UPDATING THE ELECTROPHYSIOLOGY IN NEONATAL HEARING EVALUATIONNEONATAL HEARING EVALUATION
ASSR in newbornsASSR in newborns AEP and early hearing aid fitting and AEP and early hearing aid fitting and
validation validation ASSRASSR CAEP (Obligatory Cortical Auditory Evoked CAEP (Obligatory Cortical Auditory Evoked
Potentials)Potentials)
AEP: Cochlear Implants EvaluationAEP: Cochlear Implants Evaluation
LOUDNESS AND ASSRLOUDNESS AND ASSR
Zenker Castro F., Barajas de Prat JJ & Larumbe Zabala E. (2008): Zenker Castro F., Barajas de Prat JJ & Larumbe Zabala E. (2008): Loudness and Auditory Steady State responses in normal hearing Loudness and Auditory Steady State responses in normal hearing subjects. International Journal of Audiology. In press. subjects. International Journal of Audiology. In press.
HEARING AID PRESCRIPTION FROM ASSRHEARING AID PRESCRIPTION FROM ASSR
Zenker F. & Barajas J.J.(2008) ASSRs: Their role in hearing Zenker F. & Barajas J.J.(2008) ASSRs: Their role in hearing device fitting. In: The Auditory Steady State response: device fitting. In: The Auditory Steady State response: generation, recording and clinical application. Edited by Gary generation, recording and clinical application. Edited by Gary Rance. Rance.
UPDATING THE ELECTROPHYSIOLOGY IN UPDATING THE ELECTROPHYSIOLOGY IN NEONATAL HEARING NEONATAL HEARING
ASSR in newbornsASSR in newborns AEP and early hearing aid fitting and AEP and early hearing aid fitting and
validationvalidation ASSRASSR CAEP (Obligatory Cortical Auditory Evoked CAEP (Obligatory Cortical Auditory Evoked
Potentials)Potentials)
AEP: Cochlear Implants validationAEP: Cochlear Implants validation
TYPES OF AER THAT HAVE BEEN USED TO TYPES OF AER THAT HAVE BEEN USED TO OBJECTIVELY EVALUATE HEARING AIDS OBJECTIVELY EVALUATE HEARING AIDS
FUNCTIONFUNCTION
Auditory Brainstem Responses (ABR)Auditory Brainstem Responses (ABR) Auditory Steady state Responses Auditory Steady state Responses
(ASSR)(ASSR) Obligatory Cortical Auditory Evoked Obligatory Cortical Auditory Evoked
Potential (CAEP)Potential (CAEP)
Why are we using obligatory cortical Why are we using obligatory cortical responses to evaluate hearing aid responses to evaluate hearing aid
function?function?
More likely to correlate well with More likely to correlate well with perception.perception.
Can be elicited by a range of speech Can be elicited by a range of speech phonemes. phonemes.
Reliable present in awake young Reliable present in awake young infants. infants.
Can be present in children with Can be present in children with auditory neuropathy/dys-synchrony. auditory neuropathy/dys-synchrony.
Suzanne C. Purdy et al. (2004). Aided cortical auditory evoked Suzanne C. Purdy et al. (2004). Aided cortical auditory evoked potentials for hearing instrument evaluation. 3rd Pediatric potentials for hearing instrument evaluation. 3rd Pediatric Conference “A Sound Foundattion through early amplification”. Conference “A Sound Foundattion through early amplification”. Chicago, IllinoisChicago, Illinois
CAEPCAEP
MATURATIONAL EFFECTS ON CORTICAL EVOKED MATURATIONAL EFFECTS ON CORTICAL EVOKED RESPONSERESPONSE
Ponton et al. (2000) Maturation human central auditory system Ponton et al. (2000) Maturation human central auditory system activity: evidence from multi-channel evoked potentials. Clinical activity: evidence from multi-channel evoked potentials. Clinical Neurophysiology 111 (2): 220-236Neurophysiology 111 (2): 220-236
CAEP CAN ELICITED BY DIFFERENT CAEP CAN ELICITED BY DIFFERENT SPEECH PHONEMES IN NEWBORNSSPEECH PHONEMES IN NEWBORNS
D. KURTZBERG 19899
HEARING AID GAINS AND CAEP HEARING AID GAINS AND CAEP AMPLITUDEAMPLITUDE
Suzanne C. Purdy et al. (2004). Aided cortical auditory evoked Suzanne C. Purdy et al. (2004). Aided cortical auditory evoked potentials for hearing instrument evaluation. 3rd Pediatric potentials for hearing instrument evaluation. 3rd Pediatric Conference “A Sound Foundattion through early amplification”. Conference “A Sound Foundattion through early amplification”. Chicago, IllinoisChicago, Illinois
P1 IN HEARING AIDSP1 IN HEARING AIDS
Anu Sharma, Emily Tobey, Michael Dorman, Sneha Bharadwaj, Kathryn Martin, Phillip Gilley, Fereshteh Kunkel. Central Auditory Maturation and Babbling Development in Infants With Cochlear Implants. ARCH OTOLARYNGOL HEAD NECK SURG/VOL 130, MAY 2004.
P1 IN COCHLEAR IMPLANTSP1 IN COCHLEAR IMPLANTS
Anu Sharma, Michael F. Dorman, Andrej Kral. (2005). The Anu Sharma, Michael F. Dorman, Andrej Kral. (2005). The influuence of a sensitive period on central auditory development influuence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants. in children with unilateral and bilateral cochlear implants. Hearing Research 203, 134–143.Hearing Research 203, 134–143.