Instrumentation
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ABR measures
Absolute latency
Inter-peak latency
Wave amplitudes
Threshold of wave V
Wave morphology at higher and lower click rates
Late responses
Auditory middle latency responses (AMLR):
Latency: 15-60 ms
Site of origin: Areas in brainstem and cortex
Affected by state of individual
Auditory late responses (ALR): Latency
Latency: > 60 ms
Site of origin: Areas in cortex
Affected by state of individual
Example: P300, MMN
Behavioral tests of lesion
Used to differentiate cochlear/retrocochlear site of
lesion.
Mostly replaced by OAE and electrophysiological tests.
Examples of behavioral tests:
ABLB (Alternate binaural loudness balance)
SISI (Short increment sensitivity index)
Tone decay test
ABLB
Based on phenomenon of recruitment.
In normal hearing ears and hearing loss without
recruitment, loudness grows in both ears in the same
way. Equal loudness at equal sensation levels.
Recruitment: Abnormally rapid growth of loudness in the
poorer ear. Seen in cochlear hearing loss.
Decruitment: Loudness grows very slowly in the poorer
ear. Even very intense sounds may not be very loud.
Seen in auditory nerve lesions.
Growth of loudness
SISI
Aim: To detect a small increment ( 1 dB)
superimposed on a 20 dB SL tone.
Rationale: Because of abnormal loudness
growth, individuals with cochlear hearing loss
obtain high scores (are able to detect the
increment very well).
Normal hearing listeners and retrocochlear
hearing loss obtain poor SISI scores.
Tone decay
For sustained tones, threshold increases as the duration of the tone
increases.
Steps:
1.
Present tone at 20 dB SL
2.
As soon as patient signals that the tone is heard, start stopwatch.
3.
When patient stops hearing, then increase level by 5 dB without
interrupting it.
4.
Procedure continued till a) tone is heard for 60 s, b) tone is 30 dB
above starting level and patient cannot hear for 60 s at that level, or c)
audiometric limits have been reached.
Interpretation
Type I: Tone is heard for 60 s. Seen mostly in normal-hearing listeners,
conductive hearing loss.
Type II: As level is raised, tone decay reduces (tone is heard for longer and
longer durations). Strong indicator of cochlear hearing loss.
Type III: Even with increasing levels, tone decay still observed. Indicator of
auditory nerve lesions.