ASSR Flashcards

1
Q

How is ASSR similar to the ABR?

A
  1. Surface electrodes
  2. Evoked potential
  3. Patient state
    - Unlike middle and late cortical potentials, ASSR and ABR are not affected by sleep state
  4. Quiet test environment
  5. Neural synchrony
    - Not required for every evoked potential
  6. Both are closely correlated with behavioral auditory thresholds
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2
Q

How is ASSR different from ABR?

A
  1. Objective response detection
    - Determines presence of a response for the clinician, eliminating need for subjective judgment of waveforms
  2. Up to 4 frequencies simultaneously
  3. Simultaneous R & L testing
  4. Assess profound hearing loss
  5. Modulated pure tones
    - Can obtain frequency-specific information for 250-8000 Hz
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3
Q

Why can’t you assess profound hearing loss with the ABR?

A
  • Stimuli are transient

- Can’t be presented at high stimulus levels

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4
Q

What are the advantages of ASSR?

A

Good predictor of thresholds

  • Better than click-ABR for severe/profound hearing losses
  • But not so good for normal hearing

Objective
- Automated algorithms to assess amplitude and phase coherence of response

No spectral splatter (as with transient tone bursts)

Many frequencies can be recorded at once

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5
Q

What stimuli are used in ASSR?

A
  • Steady-state
  • Stimulus is constantly on

Concern: neuronal adaptation

  • Steady signals will be ignored by the nervous system
  • Have to manipulate the stimulus

Solution: modulate the steady-state tone

  • Amplitude modulation
  • Frequency modulation
  • Mixed modulation
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6
Q

What is amplitude modulation?

A
  • Changes the intensity of the carrier frequency over time
  • Use 100% modulation because you get the best response to that rate at the upper part of the brainstem

Modulation rate= modulation frequency

ASSR is not limited to one carrier/modulator combination

  • Can test 4 frequencies simultaneously
  • As long as you use different modulation frequencies for the respective carrier frequencies, the response spectrum will be able to differentiate them
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7
Q

What is frequency modulation?

A
  • Changes frequency of the carrier frequency over time
  • Depth of frequency modulation defines the frequency range of the stimulus

20% FM for a 1000 Hz tone will cover a 200 Hz range, above and below 1000 Hz

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8
Q

What is mixed modulation?

A

Amplitude and frequency modulation

Yields most robust response

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9
Q

What is the Fc vs. Fm?

A

Carrier frequency (Fc): higher tone

  • Area that is activated on the tonotopically arranged basilar membrane
  • The frequency being tested

Modulation frequency (Fm): lower tone

  • Rate at which the tonotopiclaly stimulated area will be activated
  • Where the response is found

*Cochlea responds at Fc, but response is recorded at Fm

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10
Q

When is a neural response recorded?

A
  • Area of the BM is intact
  • 8th nerve phase-locks
  • If the ear has hearing at the Fc (e.g., 500 Hz), the brain responds at the Fm (e.g., 85 Hz)
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11
Q

What are some of the neural generators that respond to AM and FM signals?

A
  • 8th cranial nerve
  • Cochlear nucleus
  • Inferior colliculus
  • Primary auditory cortex
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12
Q

How do neural generators respond to different modulation rates?

A

<20 Hz
- Thalamus or cortex (late latency response)

20-60 Hz
- Middle-latency response

> 60 Hz
- Brainstem activity

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13
Q

Describe the conclusions from Winter (2002).

A

Results

  • 90 Hz: the largest activity occurred in the brainstem
  • 40 Hz: the initial brainstem component remained and significant activity also occurred in the cortex
  • 12 Hz: responses were small but suggested combined activation of both brainstem and cortex

Conclusion:
The whole auditory system is activated by modulated tones, but the cortex is less sensitive to modulation frequencies greater than 40 Hz

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14
Q

What is the automatic response detection algorithm?

A

Frequency domain

  • Calculate SNR
  • Compares the variance of the noise
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15
Q

What is the f-test?

A

Statistic to determine if power of response at the rate of stimulation, than EEG noise at surrounding frequencies

Response= significantly different from noise when F-ratio reaches p<0.05

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16
Q

What is phase?

A

Phase: a particular point (time) of a cycle
- A relative measurement

Reference: arbitrary zero or unshifted signal (relative phase)

  • Expressed as an angle (radians) or degrees
17
Q

What is phase analysis?

A

Response present, phase coherence
- A measure of the variability of phase; it varies from a minimum of 0 to a maximum of 1

Response absent, no phase coherence

Higher values of phase coherence indicate a lower probability that the phase is randomly changing rom epoch to epoch

18
Q

What results are yielded from ABR and ASSR when the subject has normal hearing?

A

ABR
- Accurate estimation

ASSR
- May over-estimate thresholds if patient is unsedated

19
Q

What results are yielded from ABR and ASSR when the subject has a conductive HL?

A

ABR
- Wave I can indicate whether we have ear specific findings, i.e., do not always have to mask

ASSR
- Masking required for bone condition tone burst testing

20
Q

What results are yielded from ABR and ASSR when the subject has SNHL?

A

ABR
- Accurate to moderate HL

ASSR
- Can distinguish between moderate to profound HL

21
Q

What results are yielded from ABR and ASSR when the subject has neural/auditory neuropathy?

A

ABR
- Can distinguish between sensory & neural HL (wave I/cochlear microphonic)

ASSR
- Cannot distinguish between cochlear/peripheral and retrocochlear HL

22
Q

What are the ABR test characteristics vs. ASSR test characteristics?

A

ABR

  • High level of skill required
  • Better fro estimating normal hearing
  • More online decision making flexibility
  • Absolute quiet not required
  • ABR more accurate <6-8 weeks of age

ASSR

  • Automated; avoid interpretation bias
  • Test at high dB levels: can ear be stimulated? (important for CI candidacy)
  • Many frequencies recorded at once
  • Better representation of steeply sloping hearing losses
  • Patient needs to be still