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Slide 1 Clinical Application of Auditory Evoked Responses:
The Time Has Come
James W. Hall III, Ph.D.Adjunct Professor
Nova Southeastern University
Fort Lauderdale, Florida, USA
Salus University
Elkins Park, Pennsylvania, USA
Extraordinary Professor
University of Pretoria
Pretoria, South Africa
[email protected]
www.audiologyworld.net
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Slide 2
P300
ALR
AMLR
ABR
ECochG
Clinical Application of Auditory Evoked Responses:
The Time Has Come
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Slide 3 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.
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Slide 4 Auditory Middle Latency Response (AMLR):
Analysis
100 ms
PAM
PbPa (22 - 30 ms)
PAM = Post-auricular muscle
Am
pli
tud
e (m
V)
NbNa
1 mV
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Slide 5 Auditory Middle Latency Response (AMLR):
An Example of Post-Auricular Muscle (PAM) Artifact
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Slide 6
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Slide 7 Origins of the Auditory Middle Latency Response (AMLR)
(Photograph adapted from F.E. Musiek)
Primary
Auditory
Cortex
Thalamus
(Medial
Geniculate
Body)
Thalamus
(Medial
Geniculate
Body)
Primary
Auditory
Cortex
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Slide 8 Origins of the Auditory Middle Latency Response (AMLR)
(Photograph adapted from F.E. Musiek)
Primary
Auditory
Cortex
(Superior
Temporal
Gyrus)
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Slide 9 AMLR TEST PROTOCOL (1)
Stimulus Parameters
Type Tone bursts
Duration 2 cycles of rise time and long plateau
Rate 7.1/sec or slower as necessary
Polarity Alternating or rarefaction
Intensity 70 dB nHL or less (< PAM)
Transducer Insert
Masking Rarely needed
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Slide 10 AMLR TEST PROTOCOL (2)
Acquisition Parameters
Amplification 75,000 or less
Analysis time 100 ms
Sweeps 500 or less
Filters 10 to 250 or 1500 Hz
Notch filter Never (AMLR spectrum = 40 Hz)
Electrodes *
channel 1 C5 to A1/A2 (linked earlobes) or Non-cephalic (LH)
channel 2 C6 to A1/A2 or non-cephalic (RH)
channel 3 Fz to A1/A2 or non-cephalic (ML)
• With a 2 channel AER system, record AMLR with two hemisphere
electrode array and then a single channel (Fz) recording
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Slide 11 Enhancing Detection of the Elusive Pb Wave:
Slow stimulus (< 1/sec), Low frequency stimulus (500 Hz), Very low
high pass filter setting (1 Hz)
Nelson, Hall & Jacobson, 1997
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Slide 12 Linked Earlobe Electrode Arrangement
in AMLR Measurement
1+ 1- Gnd 2+ 2-
Electrodes
1+ = Non-inverting (C6)
1- = Inverting (Ears)
Gnd = Common (Fpz)
2+ = Non-inverting (C5)
2- = Inverting (Ears)
Right Side Left Side
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Slide 13 Modification of the AMLR Test Protocol
to Record a Pb Component (ALR P1)
Stimulus Parameters
Type Tones (not clicks)
Frequencies Lower are better
Duration
rise/fall 5 ms
plateau > 10 ms
Rate < 1 signal/second
ISI > 1 second (up to 5 or 6 seconds)
Acquisition Parameters
Electrodes Cz (versus Fz)
Analysis time > 100 ms
Filters: 0.1 - 100 Hz
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Slide 14 Modification of Protocol to Record an
ABR and AMLR at the Same Time
Stimulus Parameters
Type Clicks (not tones)
Rate < 11 stimuli/sec (older children and adults)
Acquisition Parameters
Electrodes Fz-Ai (to detect an ABR wave I)
Analysis time > 100 ms
Filters: 10 to 1500 Hz
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Slide 15 Measurement and Non-Pathologic Factors
Influencing AMLR Recordings
Test Parameters:
Filtering: avoid restricted high-pass filter setting (e.g., 30 Hz) and use HP setting of < 1 Hz to detect Pb component
Stimulus intensity level: avoid very high levels (PAM artifact)
Stimulus duration: longer (> 10 ms) is better (avoid clicks)
Stimulus rate: slower rates for children and in pathology with very slow rate (< 1/sec) to detect Pb component
Subject Factors:
Age: a factor under 10 years old and interacts with rate
Sleep: AMLR more variable during sleep
Post-auricular muscle (PAM) artifact: Avoid if possible
Sedation: amplitude reduced and variable
Anesthesia: typically suppresses AMLR activity (reticular formation generators)
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Slide 16
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Slide 17 Neural Generators of the AMLR
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Slide 18 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
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Slide 19 Abnormal Patterns for Auditory Middle Latency Response (AMLR)
in Patients with Confirmed Temporal Lobe Lesions
(Musiek et al, 2007)
AMLR Component (Amplitude in mV)
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)
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Slide 20 Abnormal Patterns of AMLR with Right Hemisphere Lesion
Electrode Effect
Left Hemisphere
C5
Right Hemisphere
C6
V V
Na Na
Pa Pb
RE
LE LE
RE
Right Ear Left Ear
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Slide 21 Abnormal Patterns of AMLR with Right Hemisphere Lesion
Ear Effect
Left Hemisphere
C5
Right Hemisphere
C6
V
V
Na
Na
Pa Pb
RE
LE LE
RE
Right Ear Left Ear
Na
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Slide 22 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
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Slide 23 Normal Expectations for Electrode Effects in Pediatric
Auditory Middle Latency Response (AMLR) Recordings(Weihling, Schochat & Musiek, 2013)
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Slide 24 Normal Expectations for Ear Effects in Pediatric
Auditory Middle Latency Response (AMLR) Recordings(Weihling, Schochat & Musiek, 2013)
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Slide 25 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 Resarch, 43, 777-785
Subjects
30 children (age 8 – 14 years) with APD
22 children without APD
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
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Slide 26 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 Resarch, 43, 777-785
Diagnosis of APD
Pediatric speech intelligibility (PSI) test
Speech-in-noise test
Dichotic digits test
Dichotic non-verbal test
Auditory training protocol
Frequency discrimination training
Intensity discrimination training
Temporal (duration) discrimination training
Dichotic Inter-aural Intensity Difference (DIID
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Slide 27 Documenting Benefits of Auditory Training with
Auditory Middle Latency Response (AMLR) Responses
(Schochat E, Musiek FE, Alonso R & Ogata J, 2010)
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Slide 28 Documenting Benefits of Auditory Training with
Auditory Middle Latency Response (AMLR) Responses
(Schochat E, Musiek FE, Alonso R & Ogata J, 2010)
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Slide 29 Auditory Middle Latency Response (AMLR) Responses
in Children with Specific Language Impairment (SLI)
Al-Saif SS, Abdeltawwab MM & Khamis M. (2012) Auditory middle
latency responses amplitude responses in children with specific
language impairment. European Archives of Otorhinolaryngology,
269, 1697-1702 [Saudi Arabia]
Subjects
19 children with SLI (Arabic) with delayed language
development affecting production and reception
Normal group
Analysis of Na-Pa latency and amplitude between groups
Conclusions
No statistically significant difference between groups
Findings “cast doubt” on the hypothesis that abnormalities in
the primary auditory cortex are a cause of SLI
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Slide 30
Advantages
Accepted test protocols and procedures
Primary auditory cortex origins known
Measurable in infants and young children (but complex interaction bet/ age, stimulus rate, duration
Not influenced by
State of arousal
Behavioral response to sound (e.g, autism)
Cognitive status
Disadvantages
influenced by sleep and sedatives
Requires hemispheric electrodes for neuro-diagnostic information
Analyses strategies not well defined in CAPD
Few data on relation bet/ AMLR and behavioral CAPD findings
APD Assessment with AMLR
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Slide 31 Auditory Evoked Responses in Auditory Processing Disorders (APD):
Clinical experience in 1990s
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Slide 32 Auditory Middle Latency Response (AMLR):
Pb (P50) as Index of “Sensory Gating”(e.g., Boutros et al. Psychiatry Research 57: 1995)
ms
Pb (P50)Pa
Am
pli
tud
e (m
V)
Signal 1
1 mV
500 ms
Conventional AMLR
Habituation
(sensory gating)
Signal 2
Attention
Pb (P50)
Pb (P50)
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Slide 33 Auditory Late Response (Cortical)
600 ms
P2 (180 – 200 ms)
Am
pli
tud
e (m
V)
N2 (200 - 400 ms)N1 (90 - 150 ms)
P1 (50 ms)
5mV
Stimulus
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Slide 34 Auditory Late
Response: Generators
P300
N2
P2
N1
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Slide 35
Stimulus parameters
Stimulus: tones or speech signals (e.g., phonemes /da/ or /ga/)
Duration: relatively long, e.g.,
10 ms rise/fall
30 ms plateau
Rate: slow (< 1/sec); amplitude increases until ISI > 5 sec)
Polarity: alternating (not important)
Intensity: moderate (< 70 dB nHL)
Repetitions (averages): < 200
Auditory Late Responses (ALRs): Test Protocol (1)
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Slide 36
Acquisition parameters
Analysis time
Total: 600 ms
Post-stimulus: 500 or 600 ms
Pre-stimulus: 100 ms
Electrodes
Non-inverting: Cz (and/or Fz and other scalp locations)
Inverting: earlobes (linked)
Supra-orbital/canthus: monitor eyeblink
Amplification: < 25,000
Filter settings
Band-pass: 0.1 to 100 Hz
Notch: off
Auditory Late Responses (ALRs): Test Protocol (2)
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Slide 37 Age
Developmental changes
Maturation through at least 10 to 12 years of age
N1 and P2 amplitude decreases, and P3 amplitude increases, with development
Latency decreases with development
Advancing age
Gradual latency increase > 20 years of age for all auditory late responses
Attention
Variable for different ALR components (for P2 and P3, not N1)
Sleep
Stage of sleep affects ALRs
Variability in sleep stages 3 and 4
Responses in rapid eye movement (REM) sleep equivalent to awake state
Changes in amplitude and latency can document effective intervention for APD (see Kraus and others)
Auditory Late Responses (ALRs):
Effects of Selected Subject Factors
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Slide 38 Clinical Application of Auditory Late Responses:
Documentation and Diagnosis of APD
Kraus et al. Auditory neurophysiologic responses and
discrimination deficits in children with learning
problems. Science 273: 1996.
Cunningham, Nicol, Zecker & Kraus. Speech-evoked
neurophysiologic responses in children with learning
problems: Development and behavioral correlates of
perception. Ear & Hearing 21: 2000 [P1, N1, N2]
Dozens of new peer reviewed publications …
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Slide 39
Hayes, Warrier, Nicol, Zecker & Kraus. Neural plasticity following auditory training in children with learning problems. Clinical Neurophysiology 114: 673-684, 2003.
Subjects
27 children with auditory learning problems (age 8–12 yrs)
15 children in control group
Training
Earobics for 35 to 40 sessions (1 hour each) for about 8 wks.
Neurophysiologic measures
ABR for click and speech signals, i.e., /da/
Auditory late response N1 and P2 for /ga/ signal in quiet and /da/ signal in noise
Effectiveness of A Computer-Based Program for
Development of Auditory Processing Skills:
Documentation with the ALR
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Slide 40
Neural plasticity following auditory training in children with learning problems: Findings
Significant pre- vs. post-Earobics changes were noted for
“sound blending”
“auditory processing”
No pre- vs. post treatment change in the ABR
The P2-N2 amplitude showed significant decrease (maturation)
The N2 latency showed significant decrease (maturation)
The P2-N2 amplitude showed significant increase in noise
Conclusions
Children with auditory learning problems who completed auditory training (Earobics) exhibited plasticity of neural encoding of speech sounds at cortical level. These changes were associated with improvement in behavioral performance.
Effectiveness of A Computer-Based Program for
Development of Auditory Processing Skills:
Documentation with the ALR
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Slide 41 Auditory Evoked Responses in Auditory Processing Disorders (APD):
Clinical experience in 1990s
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Slide 42 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
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Slide 43 Clinical Applications of Auditory Late Response
(Anu Sharma, PhD, University of Colorado)
Stimulus parameters
• /ba/ with 5 formants or /uh/
• 90 ms duration for /ba/ or 23 ms for /uh/
• 70 or 75 dB SPL
• Inter-stimulus interval (ISI) = 500 ms or variable
• Stimulation via a loudspeaker 45o relative to ear
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Slide 44 Clinical Applications of Auditory Late Response
(Anu Sharma, PhD, University of Colorado)
Response parameters
• Silver-silver chloride electrodes
• Electrodes
Cz non-inverting electrode site
Mastoid (M) inverting electrode site
• 0.1 to 100 or 300 Hz band-pass filter settings
• 600 ms analysis time (100 ms pre-stimulus time)
• Eye electrodes to detect eye-blink
• > 300 sweeps per averaged waveform
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Slide 45 Clinical Applications of Auditory Late Response:
Effect of Inter-Stimulus Interval (ISI) on Detectability
(Anu Sharma, PhD, University of Colorado)
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Slide 46 Clinical Applications of Auditory Late Response:
Hearing Aid versus Cochlear Implant Performance
(Anu Sharma, PhD, University of Colorado)
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Slide 47 Clinical Applications of Auditory Late Response:
Documenting Cortical Maturation
(Anu Sharma, PhD, University of Colorado)
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Slide 48 Recording of Auditory Late Responses to Evaluate
Hearing Aid and Cochlear Implant Performance is Feasible
(Anu Sharma, PhD, University of Colorado)
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Slide 49 Clinical Applications of Auditory Late Response:
Documenting Hearing Aid Performance
(Anu Sharma, PhD, University of Colorado)
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Slide 50 Clinical Applications of Auditory Late Response:
Documenting Hearing Aid Performance
(Anu Sharma, PhD, University of Colorado)
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Slide 51 Clinical Applications of Auditory Late Response:
Evaluating Cortical Differences with Age of Cochlear Implantion
(Anu Sharma, PhD, University of Colorado)
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Slide 52 Clinical Applications of Auditory Late Response:
Hearing Aid versus Cochlear Implant Performance
(Anu Sharma, PhD, University of Colorado)
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Slide 53 Clinical Applications of Auditory Late Response:
Cochlear Implant Performance
(Anu Sharma, PhD, University of Colorado)
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Slide 54 Clinical Applications of Auditory Late Response:
Evaluation of Auditory Function in Children with ANSD
(Anu Sharma, PhD, University of Colorado)
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Slide 55 Clinical Applications of Auditory Late Response: Documenting
Hearing Aid or Cochlear Implant Performance in Patients with ANSD
(Anu Sharma, PhD, University of Colorado)
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Slide 56 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
Chapter 1. Introduction to AERPs to Words
Chapter 2. Overview of N1, P2, PN & LPC
Chapter 3. Examples of N1, P2, PN & LPC
Chapter 4. Dichotic Listening
Chapter 5. The Dichotic Plot Thickens
Chapter 6. Isolating Attention
Final Thoughts
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Slide 57 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
Listening Task = Repeating the word that is heard
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Slide 58 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
“Waveforms to forty repetitions of
the word “please” illustrating
varying subcomponents of the N1
component evident from different
electrode sites. “
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Slide 59 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
“AERP waveforms in response to
four different stimuli and tasks.
The vertical positions of the N1
and P2 peaks relative to baseline
were influenced by the degree of
PN negativity. “
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Slide 60 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
“This figure illustrates a more subtle effect
on the LPC. The participant was a young
man who emigrated from Poland to the
USA. His native language was Polish but
he was also an accomplished speaker of
English.
Although each elicited a robust LPC, the
component was slightly earlier and
slightly more positive at the peak of the
waveform at electrode PZ in the native
language, Polish. The necessary decisions
were more difficult in the English version.
“
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Slide 61 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
“A robust demonstration
of the REA in young
adults and seniors.
Listeners monitored an
ongoing narrative for
semantically or
syntactically anomalous
words.
Topographic maps reflect
substantial asymmetry of
the LPC response,
indicating that the
decision is less difficult in
the target right condition.
“
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Slide 62 Auditory Event-Related Potentials to Words:
Implications for AudiologistsJames Jerger, Jeffrey Martin & Katharine Fitzharris
Plural Publishing, in press
“A robust demonstration
of the REA in young
adults and seniors.
Listeners monitored an
ongoing narrative for
semantically or
syntactically anomalous
words.
Topographic maps reflect
substantial asymmetry of
the LPC response,
indicating that the
decision is less difficult in
the target right condition.
“
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Slide 63 Accepted test protocol
Hearing scientists use non-clinical instrumentation (NeuroScan)
Disagreement on basic test parameters, e.g., required number of electrodes
Clinical instrumentation with new features (ALR options)
Multiple channels (e.g., 4 to 8) for hemisphere and eye blink electrodes
An assortment of speech stimuli available within ALR protocols
APD protocols for measurement of ALR with:
Speech-in-noise
Dichotic listening
Temporal processing (gap detection)
Statistical analysis of ALR parameters, e.g.,
Latency and amplitude
Amplitude under the curve
Normative data (collected with clinical instrumentation)
Maturational data on ALR from infancy to adulthood (0 to 20 years)
Latency and amplitude data for various stimuli
Clinical Assessment of APD with the ALR:
How Can We Make it Happen?
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Slide 64 Cortical Auditory Evoked Responses Elicited with
Stimuli from Loudspeakers
HEARLab
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Slide 65 Auditory Evoked Responses:
Objective Site-Specific Indices of Auditory System Function
P300
ALR
AMLR
ABR
ECochG
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Slide 66
Negative “obligatory” or “exogenous” response waves
N1
N1b
N1c
N150
N400
Sustained negativity (for duration of stimulus)
Positive waves
P2
Cognitive or “endogenous” response waves
Processing negativity
MMN (mismatch negativity) response
P3 (P300)
P3a
Cognitive Auditory Evoked Responses
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Slide 67 Cognitive Auditory Evoked Responses
Historical Perspective on the P300 Response
Classic versus Passive P300 Paradigm
Anatomical Underpinnings
P300 Test Protocol
P300 versus MMN Response
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Slide 68 Co-Discoverers of the Auditory P300 ResponseHallowell Davis (1896-1992) Samuel Sutton (1921-1986)
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Slide 69 The P300 Response(Davis H, 1964; Sutton, Braren & Zubin, 1965)
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Slide 70 P300 Response:
Classic Oddball Paradigm
500 ms
Frequent
Unattended
e.g., 1000 Hz or /da/
P2
Am
pli
tud
e (m
V)
P2P3 (300)*
Infrequent
(rare)
Attended
e.g., 2000 Hz or /ga/
* P3b
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Slide 71 P300 Response:
Passive Measurement Paradigm
500 ms
Frequent
Unattended
Stimulus
e.g., 1000 Hz or /da/
P2
Am
pli
tud
e (m
V)
P2
P3a
Infrequent
Unattended
(Novel) Stimulus
e.g., 2000 Hz or /ga/
* P3b
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Slide 72 P300 Response:
Generators
P300
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Slide 73 Stimulus parameters
Stimulus: tones or speech signals (e.g., phonemes /da/ or /ga/)
Duration: relatively long, e.g.,
10 ms rise/fall
30 ms plateau
Rate: slow (< 1/sec); amplitude increases until ISI > 5 sec)
Polarity: alternating (not important)
Intensity: moderate (< 70 dB nHL)
Frequent versus Rare (oddball)
Some acoustic difference, e.g., frequency
Rare stimuli randomly presented with probability of ~20%
Repetitions (averages): < 200
P300 Response: Test Protocol (1)
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Slide 74 Acquisition parameters
Analysis time
Total: 600 ms
Post-stimulus: 500 or 600 ms
Pre-stimulus: 100 ms
Electrodes
Non-inverting: Cz (and/or Fz and other scalp locations)
Inverting: earlobes (linked)
Supra-orbital/canthus: monitor eyeblink
Amplification: < 25,000
Channels
Waveform elicited by frequent stimuli
Waveform elicited by infrequent (rare) stimuli
Filter settings
Band-pass: 0.1 to 100 Hz
Notch: off
P300 Response: Test Protocol (2)
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Slide 75
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Slide 76
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Slide 77
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Slide 78
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Slide 79
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Slide 80 Auditory P300 Response:
Different recording strategies
One stimulus P300 paradigm
Single target signal presented randomly
Standard (frequent) signal replaced by silence
Similar latency and amplitude to standard oddball paradigm
Passive P300 paradigm
Passive and single signal paradigms yield similar waveforms (latencies)
Passive = subjects listen but not required to make a response
P2 amplitude larger for single stimulus paradigm
Polich J. Comparison of P300 from a passive tone sequence paradigm
and an active discrimination task. Psychophysiology 24: 41-46, 1987.
Zenker F & Barajas J. Auditory P300 development from active, passive,
and single-tone paradigms. International Journal of Psychophysiology
33: 99-111, 1999.
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Slide 81 Auditory P300 Response:
Factors influencing latency and amplitude
Probability of rare stimulus
Shorter latency and larger amplitude with less probable stimulus
Attention
Shorter latency and larger amplitude with greater attention
Age
Latency decreases by about 19 ms/year up to age 20 years
Latency increases by 1 to 2 ms/year > age 20 years
Gender
No apparent effect
Handedness
Larger P300 amplitudes for posterior electrode locations for right handed subjects and for anterior locations for left handed subjects
Sleep
P300 response is highly variable depending on stages of sleep
P300 response is equivalent in awake and REM sleep state
Difficulty of task
Latency is longer and amplitude smaller as difficulty of task increases
Memory
Latency of P300 is related to memory as influenced by medications (decreased memory associated with increased latency)
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Slide 82 Robert Jirsa (1943-2009)The Hearing Journal, 64 (July), 20-24, 2011
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Slide 83 Robert Jirsa
P300 Response in Auditory Processing Disorders (APD)
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Slide 84
Jirsa RE & Clontz K (1990). Long Latency Event Related Potentials from Children with Auditory Processing Disorders. Ear and Hearing 11, 222-232
Jirsa RE (1992). The Clinical Utility of the P3 ERP in Children with Auditory Processing Disorders. Journal of Speech and Hearing Research, 35, 903-912
Jirsa, RE (2002). Clinical Efficacy of Electrophysiologic Measures in Auditory Processing Disorders Management Programs." Seminars in Hearing, 23, 349-356
Jirsa RE (2003). Management of Children with APDs. The Hearing Journal, 56, 42
Robert Jirsa, PhD:
Early Research on Clinical Application of P300 in Audiology
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Slide 85 Auditory Evoked Responses in Auditory Processing Disorders (APD):
Clinical Experience (Hall, 1995)
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Slide 86 American Academy of Audiology (AAA)
Clinical Guidelines on Auditory Processing Disorders
(www.audiology.org)
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Slide 87 American Academy of Audiology (AAA)
Clinical Guidelines on Auditory Processing Disorders
Role of P300 In APD (pp. 20-21)
“Although there are non-auditory contributors to the P300, there is evidence that lesions in the auditory regions of the cortex compromise the P300 in both latency and amplitude (Knight, Scabini, Woods, & Clayworth, 1989; Musiek et al, 1992).
The P300 is sensitive to compromise of the CANS, specifically to temporal lobe seizure disorder (Soysal, Atakli, Atay, Altintas, Baybas, & Arpaci, 1999).
Adults with (C)APD showed significantly longer P300 latencies than normally hearing controls in competing noise conditions (Krishnamurti, 2001).
Jirsa and Clontz (1990) also demonstrated significant differences between children with CAPD and a control group for the latency and amplitude of the P300. (Levels of evidence: 2, 3).”
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Slide 88 American Academy of Audiology (AAA)
Clinical Guidelines on Auditory Processing Disorders
Research Needs
Systematic investigation of performance on behavioral central auditory tests and electrophysiological measures in the same subject group.
Large-scale studies to establish normative data for behavioral central auditory tests and AERs across the lifespan.
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Slide 89 Clinical Applications and Basic Research
on the Auditory P300 Response
(www.nlm.nih.gov/PubMed
Linden David E. (2005). The P300 Response: Where in the brain is it produced and what does it tell us. The Neuroscientist, 11, 563-577
Email sent to author 2:38 pm July 18, 2013: “Dear Dr. Linden: Please
forward at your earliest convenience an electronic reprint of your article
entitled "The P300: Where in the Brain Is It Produced and What Does It
Tell Us?" in The Neuroscientist. Thank you. James W. Hall III
Response from author 3:35 am July 19, 2013: thanks for your interest, DL
David LindenProfessor of Translational Neuroscience
Honorary Consultant Psychiatrist, Cardiff and Vale University Health Board
Institute of Psychological Medicine and Clinical Neurosciences
MRC Centre for Neuropsychiatric Genetics and Genomics
School of Medicine, Cardiff University
Cardiff CF14 4XN, United Kingdom
Phone: +44 29 20 687 064
Fax: +44 29 20 687 068
http://medicine.cf.ac.uk/person/prof-david-linden/
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Slide 90 Clinical Applications and Basic Research
on the Auditory P300 Response
(www.nlm.nih.gov/PubMed
Linden David E. (2005). The P300 Response: Where in the brain is it produced and what does it tell us. The Neuroscientist, 11, 563-577
What is the P300 and why is it relevant?
P3a versus P3b
P300 in patient studies
Localization studies
Intracranial recordings
Lesion studies
Functional imaging
Consequences for the clinical application of P300
Genetics of P300
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Slide 91 Clinical Applications and Basic Research
on the Auditory P300 Response(Linden, 2005).
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Slide 92 Auditory P300 Response:
Clinical Populations Highlighting Audiology
Chronic alcoholism
Dementia
Alzheimer’s dementia
Cerebro-vascular accidents (CVA or stroke)
Attention deficit hyperactivity disorder (ADHD)
Auditory processing disorders (APD) in children and adults
Depression
Epilepsy
Huntington’s disease
Parkinson’s disease
Schizophrenia
Language impairment and learning disability
Autism (decreased amplitude but unchanged latency)
Traumatic brain injury (TBI)
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Slide 93 Mismatch Negativity (MMN)Elicited by Different Properties of Sound
(Courtesy of Catharine Pettigrew, Ph.D.)
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Slide 94 MISMATCH NEGATIVITY (MMN) RESPONSE:
Investigations in clinical populations
Assessment of infant speech perception, including children at risk for disorders, e.g., language (e.g., Leppanen & Lyytinen, 1997)
Hearing aid fitting of infants and young children with speech signals (e.g., Kraus, et al)
Cochlear implant fitting infants and young children with speech signals (e.g., Kraus, et al)
Documentation of auditory training and language treatment (e.g., Kujala et al, 2001)
Description of Alzheimer’s disease (e.g., Pekkonen et al, 1994)
Electrophysiologic documentation of attention deficit hyperactivity disorder (e.g., Barry, Johnstone, Clarke, 2003)
Prognosis of recovery from coma (e.g., Kane et al, 1993)
Diagnosis of frontal and auditory temporal lobe dysfunction in schizophrenia (e.g., Michie et al, 2000)
Neurophysiologic documentation of auditory processing disorder (APD) and dyslexia in children
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Slide 95 Neuroscience Evidence for APD:
Functional Neuro-Imaging (fMRI)(18 y.o. APD Patient with Right Ear Dichotic Deficit)
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Slide 96 “fMRI” and “Auditory”:
N = > 2400 Medline Citations
Bernal B, Altman NR, Medina LS. Dissecting nonverbal auditory cortex
asymmetry: an fMRI study. Int J Neurosci. 2004 May;114(5):661-80
Rowan A, Liegeois F, Vargha-Khadem F, Gadian D, Connelly A,
Baldeweg T. Cortical lateralization during verb generation: a combined
ERP and fMRI study. Neuroimage. 2004 Jun;22(2):665-75.
Okada T, Honda M, Okamoto J, Sadato N. Activation of the primary
and association auditory cortex by the transition of sound intensity: a
new method for functional examination of the auditory cortex in
humans. Neurosci Lett. 2004 Apr 8;359(1-2):119-23.
Many addtional newer peer reviewed publications …
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Slide 97 Differences Between Auditory P300 Response
and Mismatch Negative (MMN) Response(from New Handbook of Auditory Evoked Responses, 2007, p. 553)
P300
Classic protocol requires attention to rare stimulus
Response amplitude directly related to subject attention
Response amplitude directly related to task and to task relevance
Response with latency of about 300 ms
Generators in limbic system and auditory cortex
Larger differences between frequent vs. rare stimuli produce larger P300
MMN
Involves pre-perceptual detection of a change in the stimulus
Amplitude of the response is independent of subject attention to deviant stimul
Amplitude of the response is unaffected by subject task and stimulus relevance
Latency of the MMN is in the 100 to 300 ms region
There are frontal lobe contributions to the response
Smaller differences between standard and deviant stimuli produce clearest
MMN responses and minimize contamination with other late responses
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Slide 98 Thank You! … Questions?
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