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1 Equilibrium Res Vol. (3) Auditory Evoked Potentials Masaru Aoyagi Department of Otolaryngology, Yamagata University School of Medicine This article describes the basic elements of auditory evoked potentials, including stimulus tone and recording condition, and clinical applications of auditory evoked potentials, such as ECochG, ABR and ASSR. The clinical applications of auditory evoked potentials are roughly classified into (1) objective audiometry and (2) neurological examination. ECochG is applied to the diagnosis of endolymphatic hydrops and inner ear hearing loss. ABR is still an important examination in the diagnosis of acoustic neurinoma, though the prevalence of MRI has reduced its importance. The elongation of the IV inter-peak latency (IV IPL) of ABR in lower brainstem lesion is mainly due to IIII IPL elongation, whereas IV IPL elongation is mainly due to IIIV IPL elongation in upper brainstem lesions. Recruitment and conductive hearing loss can be estimated by the finding of the latency-intensity curve of wave V. Although ABR is the most popular device in objective audiometry, the prediction of hearing levels in the lower frequency range using ABR evoked by clicks is less accurate. The most important benefit of ASSR is to provide an accurate assessment of hearing at different frequencies in a frequency specific manner, if stimulation consists of a sinusoidally amplitude-modulated tone. However, ASSR is not appropriate to use as a diagnostic tool in neurological examinations, because the waveforms of ASSR consist of the interference of different wave components. Power spectrum analysis and phase coherence using fast Fourier transformation are useful for the automatic detection of ASSR, because of its sinusoidal waveform configuration. Because the detectability of ASSR changes under different arousal states, 4Hz ASSR is suitable for waking adults and 8Hz ASSR for sleeping children in the assessment of hearing. Its advantage is that the thresholds at 4 different frequencies in both ears can be predicted more rapidly than ABR using the multiple simultaneous stimulation technique. Key words: auditory evoked potential; electrocochleography (or ECochG); auditory brainstem response (or ABR); auditory steady-state response (or ASSR) ( 113 )

2 Equilibrium Res Vol. (3) MRI ABR electrocochleographyecochgsummating potentialsp cochlear microphonicscm action potentialap excitatory postsynaptic potentialepspauditory brainstem responseabrmiddle latency responsemlrslow vertex responsesvr near field potential far field potential Berger Davis V-potential Dawson Geisler MLR SVR MLR ERAevoked response audiometry Jewett Sohmer & Feinmesser ABR ABR ABR auditory steady-state responseassr ABR ASSR ABRMLRSVR ( 114 )

3 Equilibrium Res Vol. (3) ABR ABR ASSR8 Hz ASSR MLR SVR ABR ABR 48 khz ABR 5 Hz SVR MLR ABR ECochG 1V 5 ms.5v 1 ms.5v 1 ms 1V 5 ms CM SP AP 16ms ABR FFR 112 ms 6ms MLR PAR 127 ms 125 ms SVR 58 ms P 3 CNV 345 ms ASSR ( 115 )

4 Equilibrium Res Vol. (3) ABR ABR ASSR equivalent rectangular bandwidth ERB F1 khz 5 Hz 78.7 Hz1 Hz Hz ABR derived ABR notched noise ASSR ABR latency-intensity curve ASSR ASSR ABR ABR ABR ASSR 17 msec AP SPCM AP NNN ABR SP CM SP CM ( 116 )

5 Equilibrium Res Vol. (3) a b AB AB A B SP CM N1 N2 AP 5 V 1 V APSP CM CM SPAP SP AP CM CM.33 Hz APSPCM SPAP CM AP SP CM APSP CM CM APSP APSP CM inter-stimulus intervalisi 1125 msec 81 Hz SP AP notch SP AP SP SP SP SP SP SP SP SP/AP SP/AP SP/AP SP/AP SP CM 11 msec 56 msec inter- ( 117 )

6 Equilibrium Res Vol. (3) ms Duration 5 V 5 ms SP ms AP ISI 5 V 1 ms SP SP AP ISI SP -SP AP 5 V 1 ms -SP AP - SP/AP =.13 - SP/AP =.61 SP/AP negative up peak latencyipl 33, Hz 2 Hz ISI ISI 5 msec ABR ABR.2 msec ( 118 )

7 A Equilibrium Res Vol. (3) Hz R L I-V I-III I-V IPL III V I VI II VII.2 v 1 ms B Hz R L I-V III-V.2 v 1 ms ABR ABR shadow response 9 IV IPLIIII IPLIIIV IPL IV IPL ( 119 )

8 Equilibrium Res Vol. (3) ms ABR ISI53 msec IV IPL IIII IPL ABR IV IPL IIIV IPL 1 ABR 1 2 SD 9 - IPL - IPL - IPL ABR ( 1 )

9 Equilibrium Res Vol. (3) ms ABR 7 ABR ABR auditory neuropathy ABR ABR automated ABRAABR Thornton ABR template weighted-binary template-matching passrefer 35 7 ABR ASSR steady-state response; SSR ASSR Galambos 4 Hz ERPevent related potential ERP 4 Hz ASSR ASSR ASSR Galambos Kuwada sinusoidally amplitude-modulated tone SAM ASSR amplitude-modulation following responseamfr SAM CF fc Hz MF fm Hz fcfmfcfcfm Hz ( 121 )

10 Equilibrium Res Vol. (3) A B C - MAG LOG Frequency (khz) - MAG LOG 5 1 ms Frequency (khz) 5 1 ms - MAG LOG fc-fm fm fc fc+fm Frequency (khz) 5 1 ms SAM SAM CF 1 Hz MF4 Hz MF6 Hz SAM MF MF4 Hz SAM MF8 Hz SAM AMFR ASSR SAM ASSR AM Navigator Pro mixed modulationmmaudera ASSR MM AM SAM MMAM SAM Hz ASSR Hz ASSR MF 3 Hz 4 Hz 5 Hz ms ASSR SAM ASSR SAM MF SAM CF 1 Hz AMFRSAM ASSR ASSR MF Galambos ( 122 )

11 Equilibrium Res Vol. (3) 4 Hz ASSR MF 4 Hz 4 Hz ASSR 4 Hz ASSR MF(Hz) A * B C * * * * ms MF 1 Hz ASSR CF 1 Hz 5 nhl MF 4 Hz MF 6 Hz MF 8 Hz MF 1 Hz MF 1 Hz MF 81 Hz 8 Hz ASSR 4 Hz ASSR 8 Hz ASSR low frequency ASSR high frequency ASSR Hz ASSR MLR steady-state version 8 Hz ASSR ABR steady-state version ASSR fast Fourier transformfft F test Navigator Pro A CF=1 Hz MF= 4 Hz C B phase delay 5 1 Hz D-a 9 D-b ms Hz 45 Hz FFT ASSR SAMCF5 HzMF4 Hz phase coherence ground average 4 Hz phase delay4 Hz 45 Hz Picton TW ( 123 )

12 Equilibrium Res Vol. (3) phase coherence Valdez 5 Hz 1 Hz Hz 5 1 ms CF5 Hz1 Hz Hz SAM MF 4 HzCF5 Hz SAM 5 Hz CF1 Hz SAM 1 Hz CF ASSR ABR 8 Hz ASSR 8 Hz ASSR 8 Hz ASSR 8 Hz ASSR Multiple simultaneous stimulation technique ASSR ABR ASSR MASTERmultiple auditory steady-state response PictonLins 4 Hz kHz Hz ASSR 8 Hz ASSR ASSR ( 124 )

13 Equilibrium Res Vol. (3) A B C D CF MF CF MF 5 Hz 77 Hz 5 Hz 81 Hz 1 Hz 85 Hz 1 Hz 89 Hz Hz 93 Hz Hz 97 Hz 4 Hz 11 Hz 4 Hz 15 Hz 4 Hz Hz 1 Hz 5 Hz Hz Multiple simultaneous stimulation technique SAM SAM CF MF MF CF MF CF 711 Hz MF SAM SAM MF MF CF MF SAM CF MF F test CF 5 4 Hz AMFR 54 Hz MRI ABR ABR AABR ABR ASSR ABR auditory neuropathy SAM ASSR MM ASSR Audiol Jpn 26: , 1983 Derived ABR Equilibrium Res 52: , 1993 Glasberg BR, Moore BCJ: Derivation of auditory filter shapes from notchednoise data. Hearing Res 47: 13138, 199 Picton TW, John MS, Dimitrijevic A, et al.: Human auditory steadystate responses. International J Audiol 42: , 3 Aiken SJ, Picton TW: Envelope following responses to natural vowels. Audiol Neurootol 11: , 6 CLIENT 21 ( 125 )

14 Equilibrium Res Vol. (3) Thornton AR: Technical consideration in recording the ABR. In Starr A, Rosenberg C, Don M, Davis H (eds), Sensory evoked potentials 1. An international conference on standards for auditory brainstem response ( ABR) testing. Milan : Centro Ricerche e Studi Amplifon, , 1984 Galambos R, Makeig S, Talmachoff PJ: A 4 Hz auditory potential recorded from the human scalp. Proc Natl Acad Sci USA 78: , 1981 Kuwada S, Batra R, Maher VL: Scalp potentials of normal and hearingimpaired subjects in response to sinusoidally amplitudemodulated tones. Hearing Res 21: , 1986 Aoyagi M, Kiren T, Kim Y, et al.: Optimal modulation frequency for amplitudemodulation following response in young children during sleep. Hearing Res 65: , 1993 Aoyagi M, Fuse T, Suzuki T, et al.: An application of phase spectral analysis to amplitude modulation following response. Acta Otolaryngol Suppl. 54: 8288, 1993 Valdez JL, PerezAbalo MC, Martin V, et al.: Comparison of statistical indicators for the automatic detection of 8 Hz auditory steady state response. Ear & Hearing 18: 4429, 1997 Lins OG, Picton TW, Picton PP, et al.: Brainstem auditory steadystate response to multiple simultaneous stimuli. J Acoust Soc Am 95: , 1994 ( 126 )

REJECT}\grave{}$ $\grave{}\ovalbox{\tt\small -, ) $I$ Characteristics and modeling of averaging waveforms of Auditory Brainstem Res

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