Determination and evaluation of clinically efficient stopping criteria for the multiple auditory steady-state response technique

Background: Although the auditory steady-state response (ASSR) technique utilizes objective statistical detection algorithms to estimate behavioural hearing thresholds, the audiologist still has to decide when to terminate ASSR recordings introducing once more a certain degree of subjectivity. Aims: The present study aimed at establishing clinically efficient stopping criteria for a multiple 80-Hz ASSR system. Methods: In Experiment 1, data of 31 normal hearing subjects were analyzed off-line to propose stopping rules. Consequently, ASSR recordings will be stopped when (1) all 8 responses reach significance and significance can be maintained for 8 consecutive sweeps; (2) the mean noise levels were ≤ 4 nV (if at this “≤ 4-nV” criterion, p-values were between 0.05 and 0.1, measurements were extended only once by 8 sweeps); and (3) a maximum amount of 48 sweeps was attained. In Experiment 2, these stopping criteria were applied on 10 normal hearing and 10 hearing-impaired adults to asses the efficiency. Results: The application of these stopping rules resulted in ASSR threshold values that were comparable to other multiple-ASSR research with normal hearing and hearing-impaired adults. Furthermore, in 80% of the cases, ASSR thresholds could be obtained within a time-frame of 1 hour. Investigating the significant response-amplitudes of the hearing-impaired adults through cumulative curves indicated that probably a higher noise-stop criterion than “≤ 4 nV” can be used. Conclusions: The proposed stopping rules can be used in adults to determine accurate ASSR thresholds within an acceptable time-frame of about 1 hour. However, additional research with infants and adults with varying degrees and configurations of hearing loss is needed to optimize these criteria

Development and Characterization of Ear-EEG for Real-Life Brain-Monitoring

Functional brain monitoring methods for neuroscience and medical diagnostics have until recently been limited to laboratory settings. However, there is a great potential for studying the human brain in the everyday life, with measurements performed in more realistic real-life settings. Electroencephalography (EEG) can be measured in real-life using wearable EEG equipment. Current wearable EEG devices are typically based on scalp electrodes, causing the devices to be visible and often uncomfortable to wear for long-term recordings. Ear-EEG is a method where EEG is recorded from electrodes placed in the ear. The Ear-EEG supports non-invasive long-term recordings of EEG in real-life in a discreet way. This Ph.D. project concerns the characterization and development of ear-EEG for real-life brain-monitoring. This was addressed through characterization of physiological artifacts in real-life settings, development and characterization of dry-contact electrodes for real-life ear-EEG acquisition, measurements of ear-EEG in real-life, and development of a method for mapping cortical sources to the ear. Characterization of physiological artifacts showed a similar artifact level for recordings from ear electrodes and temporal lobe scalp electrodes. Dry-contact electrodes and flexible earpieces were developed to increase the comfort and user-friendliness of the ear-EEG. In addition, electronic instrumentation was developed to allow implementation in a hearing-aid-sized ear-EEG device. Ear-EEG measurements performed in real-life settings with the dry-contact electrodes, were comparable to temporal lobe scalp EEG, when referenced to a Cz scalp electrode. However, the recordings showed that further development of the earpieces and electrodes are needed to obtain a satisfying recording quality, when the reference is located close to or in the ear. Mapping of the electric fields from well-defined cortical sources to the ear, showed good agreement with previous ear-EEG studies and has the potential to provide valuable information for future development of the ear-EEG method. The Ph.D. project showed that ear-EEG measurements can be performed in real-life, with dry-contact electrodes. The brain processes studied, were established with comparable clarity on recordings from temporal lobe scalp and ear electrodes. With further development of the earpieces, electrodes, and electronic instrumentation, it appears to be realistic to implement ear-EEG into unobtrusive and user-friendly devices for monitoring of human brain processes in real-life

Longitudinal comparison of auditory steady-state evoked potentials in preterm and term infants : the maturation process

Introduction Preterm neonates are at risk of changes in their auditory system development, which explains the need for auditory monitoring of this population. The Auditory Steady-State Response (ASSR) is an objective method that allows obtaining the electrophysiological thresholds with greater applicability in neonatal and pediatric population. Objective The purpose of this study is to compare the ASSR thresholds in preterm and term infants evaluated during two stages. Method The study included 63 normal hearing neonates: 33 preterm and 30 term. They underwent assessment of ASSR in both ears simultaneously through insert phones in the frequencies of 500 to 4000Hz with the amplitude modulated from 77 to 103Hz. We presented the intensity at a decreasing level to detect the minimum level of responses. At 18 months, 26 of 33 preterm infants returned for the new assessment for ASSR and were compared with 30 full-term infants. We compared between groups according to gestational age. Results Electrophysiological thresholds were higher in preterm than in full-term neonates (p 0.05) in all the variables described. Conclusion In the first evaluation preterm had higher thresholds in ASSR. There was no difference at 18 months of age, showing the auditory maturation of preterm infants throughout their development

Validation of soft multipin dry EEG electrodes

Current developments towards multipin, dry electrodes in electroencephalography (EEG) are promising for applications in non-laboratory environments. Dry electrodes do not require the application of conductive gel, which mostly confines the use of gel EEG systems to the laboratory environment. The aim of this study is to validate soft, multipin, dry EEG electrodes by comparing their performance to conventional gel EEG electrodes. Fifteen healthy volunteers performed three tasks, with a 32-channel gel EEG system and a 32-channel dry EEG system: the 40 Hz Auditory Steady-State Response (ASSR), the checkerboard paradigm, and an eyes open/closed task. Within-subject analyses were performed to compare the signal quality in the time, frequency, and spatial domains. The results showed strong similarities between the two systems in the time and frequency domains, with strong correlations of the visual (ρ = 0.89) and auditory evoked potential (ρ = 0.81), and moderate to strong correlations for the alpha band during eye closure (ρ = 0.81–0.86) and the 40 Hz-ASSR power (ρ = 0.66–0.72), respectively. However, delta and theta band power was significantly increased, and the signal-to-noise ratio was significantly decreased for the dry EEG system. Topographical distributions were comparable for both systems. Moreover, the application time of the dry EEG system was significantly shorter (8 min). It can be concluded that the soft, multipin dry EEG system can be used in brain activity research with similar accuracy as conventional gel electrodes

Utilization of the chirp stimulus in auditory brainstem response measurements

Välittömästi äänistimulusta seuraavaa, aivorungosta lähtöisin olevaa sähköistä aktiviteettia kutsutaan auditoriseksi aivorunkovasteeksi (ABR, auditory brainstem response). ABR:ää käytetään laajalti kuulon objektiiviseen testaamiseen. Siinä missä perinteisessä äänesaudiometriassa koehenkilön tulee vastata testiääniin ennalta määrätyllä tavalla, ABR voidaan mitata ilman koehenkilön aktiivista osallistumista. Hiljattain ABR-mittauksia varten on kehitetty uudenlainen stimulus: chirp. Chirpin tarkoituksena on tuottaa suurempi ABR-amplitudi lisäämällä sisäkorvan karvasolujen aktiviteetin yhtäaikaisuutta. 1,5 - 2-kertaisia parannuksia onkin raportoitu verrattuna perinteisiin stimuluksiin. Tässä työssä perinteisiä click- ja tone burst -stimuluksia on vertailtu vastaaviin laajakaistaiseen chirpiin ja taajuusspesifeihin kapeakaistaisiin chirpeihin. ABR-kynnystasoja vertailtiin myös toisella objektiivisella metodilla, ASSR:llä saatuihin kynnystasoihin. Vasteet mitattiin kuudelta normaalikuuloiselta ja viideltä huonokuuloiselta koehenkilöltä Interacousticsin Eclipse-järjestelmällä. Perinteisten ja chirp-stimulusten eroja tutkittiin vertailemalla normaalikuuloisilta mitattujen vasteiden amplitudeja. Myös kaikilta koehenkilöiltä mitattuja kynnysarvoja verrattiin äänesaudiometrialla määriteltyihin kuulokynnyksiin. Tulosten perusteella perinteisten stimulusten ja vastaavien chirp stimulusten välillä ei löytynyt tilastollisesti merkitseviä eroja. ASSR- ja ABR-kynnysarvojen luotettava vertailu ei myöskään ollut mahdollista johtuen saatujen kynnysarvojen pienestä määrästä. Johtopäätöksissä todettiin, että tuloksiin on todennäköisesti vaikuttanut tutkimuksessa käytettyjen kuulokkeiden tyyppi. Aiemmissa, chirpin paremmuuden kannalla olleissa tutkimuksissa, mittaukset tehtiin käyttäen toista kuulokemallia. Myös kuulonaleneman vaikutukset chirp stimuluksella suoritettuihin ABR-mittauksiin ovat huonosti tunnettuja, antaen aihetta jatkotutkimuksille.The electrical activity originating from the auditory structures of the brainstem is called the auditory brainstem response (ABR). The ABR is used widely for objective assessment of the hearing system. Whereas traditional pure tone audiometry requires the test subject to respond to probe tones in a predefined manner, the ABR can be recorded without any active participation of the subject. Recently, a new kind of stimulus has been developed for ABR measurements. This stimulus, called chirp, aims at increasing the ABR amplitude by promoting synchronous firing of the hair cells in the inner ear. 1,5 - 2 times higher ABR amplitudes have indeed been recorded using the chirp when compared to traditional stimuli. In this thesis, traditional click and tone burst stimuli were compared to corresponding chirp variants; the broadband chirp and frequency-specific narrowband chirps. Also, the ABR results were compared to those obtained by another objective method, the auditory steady-state response (ASSR). Responses were obtained from six normal-hearing subjects and five hard-of-hearing subjects using the Eclipse platform from Interacoustics. In normal-hearing subjects, the ABR amplitudes were compared between traditional and chirp stimuli. In all subjects, ABR and ASSR thresholds were compared to the behavioral thresholds. Results failed to show significant differences between traditional stimuli and corresponding chirp variants. Also, comparison of and ASSR thresholds could not be done reliably because of the small number of obtained thresholds. It was concluded that the results were influenced by the type of the insert earphones used in this study. Previous results in favour of the chirp have been obtained using a different type of earphones. Also, it was suggested that the influence of hearing loss on chirp-elicited ABRs be investigated in the future

A profile of the auditory function of children with TB receiving ototoxic medication at Brooklyn Chest Hospital

Includes abstract.Includes bibliographical references.A descriptive survey research design was used to describe the auditory function of children with tuberculosis (TB) receiving ototoxic medication at Brooklyn Chest Hospital. A battery of audiologic tests (otoscopy, immittance, audiometry or OAE and AABR) were conducted on 29 children, aged 0 to 18 years, and the results were analysed using descriptive statistics and Generalized Linear Models. The results suggest that 55% of children had middle ear abnormality and 48% had hearing loss. The degree of hearing loss ranged from mild to profound in 41 % of the cases while 59% had hearing within the normal range with their loss restricted to high frequencies. No statistically significant associations were found between sex, duration of hospitalization, comorbid presentation of HIV and TB and middle ear abnormality

Real-time detection of auditory : steady-state brainstem potentials evoked by auditory stimuli

The auditory steady-state response (ASSR) is advantageous against other hearing techniques because of its capability in providing objective and frequency specific information. The objectives are to reduce the lengthy test duration, and improve the signal detection rate and the robustness of the detection against the background noise and unwanted artefacts.Two prominent state estimation techniques of Luenberger observer and Kalman filter have been used in the development of the autonomous ASSR detection scheme. Both techniques are real-time implementable, while the challenges faced in the application of the observer and Kalman filter techniques are the very poor SNR (could be as low as −30dB) of ASSRs and unknown statistics of the noise. Dual-channel architecture is proposed, one is for the estimate of sinusoid and the other for the estimate of the background noise. Simulation and experimental studies were also conducted to evaluate the performances of the developed ASSR detection scheme, and to compare the new method with other conventional techniques. In general, both the state estimation techniques within the detection scheme produced comparable results as compared to the conventional techniques, but achieved significant measurement time reduction in some cases. A guide is given for the determination of the observer gains, while an adaptive algorithm has been used for adjustment of the gains in the Kalman filters.In order to enhance the robustness of the ASSR detection scheme with adaptive Kalman filters against possible artefacts (outliers), a multisensory data fusion approach is used to combine both standard mean operation and median operation in the ASSR detection algorithm. In addition, a self-tuned statistical-based thresholding using the regression technique is applied in the autonomous ASSR detection scheme. The scheme with adaptive Kalman filters is capable of estimating the variances of system and background noise to improve the ASSR detection rate