Graeme Clark Collection
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ItemClinical findings for a group of infants and young children with auditory neuropathy( 1999)Objective: To examine the prevalence of auditory neuropathy in a group of infants at risk for hearing impairment and to present an overview of the clinical findings for affected children. Design: Results for 20 subjects who showed repeatable cochlear microphonic potentials in the absence of click-evoked auditory brain stem responses are included in this study. Behavioral and steady state evoked potential thresholds were established in each case. Where possible, otoacoustic emission and speech perception results (unaided and aided) also were obtained. Results: One in 433 (0.23%) of the children in our series had evidence of auditory neuropathy. The audiometric findings for these subjects varied significantly, with behavioural thresholds ranging from normal to profound levels. Discrimination skills were also variable. Approximately half of the subjects showed little understanding, or even awareness, of speech inputs in both the unaided and aided conditions. There were, however, a number of children who could score at significant levels on speech discrimination tasks and who benefited from the provision of amplification. Conclusion: The results suggest that auditory neuropathy is more common in the infant population than previously suspected. The effects of neuropathy on auditory function appear to be idiosyncratic, producing significant variations in both the detection and discrimination of auditory signals. As such, the management of children with this disorder must allow for individual differences.
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ItemSteady-state evoked potential and behavioural hearing thresholds in a group of children with absent click-evoked auditory brain stem response( 1998)Objective: 1) To examine the distribution of behavioural hearing thresholds in a group of children who had shown no click-evoked auditory brain stem response (ABR) at maximum presentation levels. 2) To describe the relationship between the 90 Hz steady-state evoked potential (SSEP) and behavioural thresholds in these subjects. Design: A retrospective study based on clinical findings obtained from 108 infants and young children. Each of these children had shown no recordable ABR to clicks presented at maximum levels (100 dB nHL). SSEP audiograms were obtained using AM/FM tones at the octave frequencies 250 to 4000 Hz. The results of these evoked potential assessments were compared with hearing thresholds established behaviourally. Results: Click-ABR assessment could not differentiate between the subjects in our sample with total hearing losses and those with useful residual hearing. Although some of the ears were anacusic, more than a quarter showed residual hearing ate each of the audiometric frequencies. Furthermore, at least 10% of the behavioural thresholds at each frequency fell within the moderate/severe hearing loss range. A far closer relationship was observed between SSEP and hearing thresholds. On occasions where the SSEP was absent at maximum levels, 99.5% of the ears showed either a total loss or a behavioural threshold within 10 dB of that level. When an SSEP was obtained, the hearing threshold was typically within 5 dB of the SSEP threshold. Conclusion: The results suggested that in our group of selected subjects, the SSEP technique was able to assess ears with only minimal amounts of residual hearing. Where the brevity of the acoustic click limits both its frequency specificity and its presentation level, the modulated tones used for SSEP testing allow accurate, frequency-specific assessment at high presentation levels.
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ItemThe automated prediction of hearing thresholds in sleeping subjects using auditory steady-state evoked potentials( 1995)Objective: To examine the relationship between auditory steady-state evoked potentials (SSEPs) and behavioral thresholds in sleeping subjects. Design: 60 adults and children with hearing thresholds ranging from normal to profound were selected on the basis of appropriate audiograms. Behavioral audiograms were determined at the octave frequencies 250-4000 Hz. These behavioral thresholds were then compared with the SSEP thresholds obtained during natural sleep for adults, or natural or sedated sleep for children. Results: A strong relationship between behavioural and SSEP thresholds was observed. The strength of the relationship increased with increasing frequency and increasing degree of the loss. On the basis of these data, the prediction of behavioural thresholds from SSEP levels was determined. It was found that the standard deviation of the error in this prediction decreased with increasing frequency and increasing degree of the loss. There was no significant age effect in the results obtained at any of the frequencies. Conclusion: The results suggest that the SSEP technique can be used as a predictor of behavioural thresholds in adults and children at the frequencies 250-4000 Hz.
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ItemAccuracy of behavioural threshold prediction using steady-state evoked potentials [Abstract]( 1994)This paper examines the confidence with which predictions of hearing level can be made using the steady-state evoked potential (SSEP) technique. Steady-state evoked potentials are scalp potentials that can be elicited in response to sinusoidally amplitude and/or frequency modulated tones in sleeping or awake subjects. SSEP thresholds were obtained using frequency specific stimuli at octave frequencies between 250Hz and 4000Hz in 25 children and 35 adults with varying degrees of sensori-neural hearing loss. These levels, determined automatically by a computerised detection system, were then compared with thresholds obtained behaviourally. Linear regression analyses of this data have shown that the SSEP procedure allows objective estimates of hearing level to be made for a range of carrier frequencies to within 10dB accuracy on 96% of occasions.
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ItemThe diagnostic assessment of infants using steady-state evoked potentials [Abstract]( 1994)This paper examines the relationship between the steady-state potential and behavioural thresholds obtained in two groups of young children. The first group consists of 10 babies referred to the Victorian Children's Hearing Centre following abnormal findings on screening ABR assessments. The second group contains 20 difficult to test infants who had unconfirmed hearing losses at the time of the SSEP assessment. The hearing levels predicted by the regression lines (described in the companion paper presented at this conference) were in close agreement with the behavioural levels obtained subsequently from children in both groups.
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ItemSteady state evoked potentials: a new tool for the accurate assessment of hearing in cochlear implant candidates( 1993)Precise determination of residual hearing in prospective cochlear implant candidates is essential. As the minimum age of implantation for young children has reduced, the use of objective measures of hearing has become more important. At the University of Melbourne Cochlear Implant Clinic, steady state evoked potential (SSEP) assessments are routinely carried out on all candidates under the age of 5 years using a microcomputer and custom-designed hardware in the manner described by Cohen et al. [1].
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ItemPre-operative hearing assessment in young cochlear implant candidates( 2000)Early implantation of congenitally deaf candidates is now a goal of most cochlear implant clinics. This objective can only be achieved through the use of audiological tests that are able to identify and quantify hearing loss in infancy. Behavioural conditioning techniques provide the most accurate indication of hearing acuity in older subjects, but these procedures are unreliable in young (6 months) or developmentally delayed children. This paper investigates the degree of accuracy with which two electrophysiological test techniques (click-ABR & steady-state evoked potential [SSEPD can be used to assess auditory function in infants with significant hearing loss. ABR and SSEP findings from 108 children were compared with hearing levels obtained behaviourally.
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ItemObjective hearing level estimation in infants with severe to profound impairment: role of Steady State Evoked Potential threshold testing [Abstract]( 1998)Accurate determination of hearing levels in potential cochlear implant candidates is an important part of pre-operative investigation. This is particularly the case for children younger than two years of age in whom speech perception testing is not possible. We have found the Steady-State Evoked Potential (SSEP) technique to be a reliable and accurate objective measure of residual hearing. Threshold estimation using the click-evoked auditory brainstem response cannot quantify hearing loss in the severe to profound range because of the presentation level restriction (? 100 dBnHL) and the broadband stimulus. The SSEP technique employs modulated tones at levels as high as 120 dBHL and can be used to estimate the audiograms of subjects with little or no residual hearing and absent click-auditory brainstem responses. We have demonstrated a strong relationship between behavioural and SSEP thresholds and believe that the procedure provides an important safeguard in the paediatric selection process. The possible exception is in children with retrocochlear abnormalities such as �Auditory Neuropathy�. In these subjects we have found poorer correlation between SSEP and behavioural thresholds.
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ItemSteady state evoked potentials (SSEPs): An objective measure of residual hearing in young cochlear imlpant candidates( 1993)The use of objective measures of residual hearing in young cochlear implant candidates has become more important as the minimum age of implantation has reduced. This paper examines the use of the steady-state evoked potential (SSEP) technique in the assessment of these children. SSEP thresholds were obtained using frequency specific stimuli at octave frequencies between 250llz and 4000Hz in ZS children with moderate to severe hearing losses. These levels, determined automatically by a computerized detection system were then compared with thresholds obtained behaviourally. Data was also collected from a group of 35 adult subjects with varying degrees of sensorineural hearing loss. Results indicate that the steady-state evoked potential procedure can provide accurate, frequency specific estimates of hearing thresholds in ears with even profound or total hearing losses.
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ItemSteady state evoked potentials: an objective measure of residual hearing in young cochlear implant candidates [Abstract]( 1993)Precise determination of hearing thresholds in prospective cochlear implant candidates is essential. As the minimum age of implantation for youl1g children has been reduced, the use of objective measures of hearing has become an important part of their pre-operative evaluation. Steady-state evoked potentials are scalp potentials elicited in response to sinusoidally amplitude and/or frequency modulated tones. A system has been developed at The University of Melbourne which allows the presence: of such a response to be detected automatically thus permitting an objective. frequency specific estimate of hearing to be made in sleeping or awake subjects. This paper investigates the use of SSEPs in determining hearing thresholds in young profoundly deaf children. Responses in such patients are compared with those: obtained in neonates, and a group of sleeping adult subjects with varying degrees of sensori-neural hearing loss. Results indicate that the SSE? procedure is well suited as a measure assessing residual hearing in profoundly deaf children suitable for a cochlear implant in that it can provide an accurate estimate of auditory thresholds using frequency specific stimuli presented at high levels.