Simultaneous Acquisition of 80 Hz ASSRs and ABRs From Quasi ASSRs for Threshold Estimation

Characteristics of the Deconvolved Transient AEP from 80 Hz Steady-State Responses to Amplitude Modulation Stimulation

This study aimed to validate the existence and investigate the characteristics of the transient responses from conventional auditory steady-state responses (ASSRs) using deconvolution methods capable of dealing with amplitude modulated (AM) stimulation. Conventional ASSRs to seven stimulus rates were recorded from 17 participants. A deconvolution method was selected and modified to accommodate the AM stimulation. The calculated responses were examined in terms of temporal features with respect to different combinations of stimulus rates. Stable transient responses consisting of early stage brainstem responses and middle latency responses were reconstructed consistently for all rate combinations, which indicates that the superposition hypothesis is applicable to the generation of approximately 80 Hz ASSRs evoked by AM tones (AM-ASSRs). The new transient responses are characterized by three pairs of peak-troughs named as n₀p₀, n₁p₁, and n₂p₂ within 40 ms. Compared with conventional ABR-MLRs, the n₀p₀ indicates the first neural activity where p₀ might represent the main ABR components; the n₁ is the counterpart of N10; the p₂ is corresponding to the robust Pa at about 30 ms; the p₁ and n₂ are absent of real counterparts. The peak-peak amplitudes show a slight decrease with increasing stimulation rate from 75 to 95 Hz whereas the peak latencies change differently, which is consistent with the known rate-effect on AEPs. This is direct evidence for a transient response derived from AM-ASSRs for the first time. The characteristic components offer insight into the constitution of AM-ASSRs and may be promising in clinical applications and fundamental studies.

[Intraoperative monitoring of cochlear nerve function during cerebello-pontine angle surgery]

BACKGROUND

Surgical procedures in the cerebello-pontine angle (CPA), e. g. for vestibular schwannoma, have an increased risk for damage to the cochlear nerve. Consequently, hearing deterioration up to complete deafness may result with severe impact on quality of life. Methods for intraoperative monitoring of function may minimize such risks.

OBJECTIVE

Review of current methods for intraoperative monitoring of the cochelar nerve and summary of new developments.

MATERIALS AND METHODS

Analysis and summary of literature, discussion of new methods.

RESULTS

Early auditory evoked potentials using click stimuli remain the standard method for intraoperative monitoring of cochlear nerve function. Amplitude and latency changes indicate a risk of postoperative hearing deterioration; however demonstrate only limited further differentiation of hearing quality. As novel methods, near-field recordings may allow faster feedback and auditory steady state responses potentially enable frequency specific testing.

CONCLUSIONS

Intraoperative monitoring of the cochlear nerve is an integral component of CPA surgery. It enables detection of potential nerve damage and thus contributes to avoiding postoperative functional deficits. Development and implementation of novel and additional approaches may further improve its clinical value.

Intraoperative auditory steady-state monitoring during surgery in the cerebellopontine angle for estimation of postoperative hearing classes

OBJECTIVE Brainstem auditory evoked potentials (BAEPs) have been used for intraoperative monitoring of the auditory nerve for many years. However, BAEPs yield limited information about the expected postoperative hearing quality and speech perception. The auditory steady-state response (ASSR) enables objective audiograms to be obtained in patients under anesthesia. These ASSRs could be used for intraoperative estimation of hearing classes to improve the postoperative outcome and quality of life. Studies investigating the clinical use of ASSRs during total intravenous anesthesia are currently lacking. The work presented in this article therefore investigates the application of ASSRs for intraoperative estimation of hearing classes. METHODS In 43 patients undergoing surgery for vestibular schwannoma, ASSR measurements were performed at the beginning and end of the surgical procedure. ASSR stimuli consisted of 80-dB hearing level amplitude-modulated tones with 5-minute duration, 90-Hz modulation, and 3 different carrier frequencies: 500, 1000, and 2000 Hz. Stimulation was performed unilaterally with and without contralateral masking, using single and combined carriers. Evoked responses were recorded and analyzed in the frequency domain. ASSRs were compared with extraoperative hearing classes and BAEPs using ANOVA, correlation, and receiver operating characteristic statistics. RESULTS ASSRs yielded high and consistent area under the curve (AUC) values (mean 0.83) and correlation values (mean -0.63), indicating reliable prediction of hearing classes. Analysis of BAEP amplitude changes showed lower AUC (mean 0.79) and correlation values (0.63, 0.37, and 0.50 for Waves I, III, and V, respectively). Latencies showed low AUC values (mean 0.6) and no significant correlation. Combination of several carriers for simultaneous evaluation reduced ASSR amplitudes and respective AUC values. Contralateral masking did not show a significant effect. CONCLUSIONS ASSRs robustly estimate hearing class in patients under total intravenous anesthesia, even when using short measurement durations. The method provides a diagnostic performance that exceeds conventional BAEP monitoring and enables objective and automated evaluation. On the basis of these findings, continuous intraoperative auditory monitoring could become a promising alternative or adjunct to BAEPs.

Towards an optimal paradigm for intraoperative auditory nerve monitoring with auditory steady state responses

Auditory steady state responses (ASSR) may offer an alternative to brainstem auditory evoked potentials for monitoring of the auditory nerve during surgical procedures. In the current study, we evaluated the influence of noise on ASSR characteristics in total intravenous anesthesia (TIVA). Simulated ASSR in real noise recorded during surgery under TIVA were constructed with known parameters. Influence of amplitude, modulation frequency, averaging sweeps and detection threshold on ASSR were evaluated. High amplitude, more sweeps and a liberal threshold facilitated detection. High amplitude ASSR (80 nV) were detected in up to 45 % with 16 s of data, in 80-90 % with 112 s. Near-threshold ASSR were detected in 0.8-25 %. False positives ranged between 0.3 and 10.3 %. Number of sweeps did not influence false positives. Amplitude errors varied between -61 and +39 % and improved with more averages but not with different thresholds. Modulation rate demonstrated the strongest influence on all parameters. 110 Hz yielded best, 90 Hz the worst results. Choice of parameters strongly influences detection and characteristics of ASSR. Optimal parameters enabled detection after 16 s in 45 %. Due to specific noise characteristics, modulation has a critical impact, which is currently not sufficiently recognized in ASSR studies.

Viability of intraoperative auditory steady state responses during intracranial surgery

BACKGROUND

For intraoperative monitoring of auditory nerve function, the auditory steady-state response (ASSR) analysis may be an alternative to brain stem auditory evoked potentials, offering frequency specificity and short detection times. Clinical studies investigating the viability of ASSR under total intravenous anesthesia have not been performed.

METHODS

During craniotomy under total intravenous anesthesia with propofol and remifentanil in 20 patients, ASSR were recorded. An additional control patient undergoing cerebellopontine angle surgery was included, in whom the auditory nerve could not be preserved. One-minute sinus tones (500, 1,000, 2,000 Hz) were applied with 60-, 70-, and 80-decibel hearing level. Stimuli were amplitude modulated with 40, 90, or 110 Hz and applied monaurally to the left and right ears. Time to detect a significant response and response amplitudes at 40, 90, or 110 Hz in the evoked EEG spectra was evaluated.

RESULTS

Overall, 90-Hz ASSR were successfully detected in all 20 patients, 110 Hz in 18 patients, and 40 Hz in 14 patients after a median of 10 seconds. No ASSR could be detected in the control patient at the end of the surgical procedure. Time-to-significance and ASSR amplitudes were influenced by stimulus intensity, carrier, and modulation frequency (Scheirer-Ray-Hare test, P < 0.005). Ipsilateral responses were higher than contralateral (P < 0.0001).

CONCLUSIONS

In conclusion, 90- and 110-Hz ASSR can be reliably detected under total intravenous anesthesia. Our results are in line with those from previous studies in awake patients. Auditory steady-state response during anesthesia may enable intraoperative frequency-specific audiometry and monitoring of the auditory nerve.

Unwrapping of transient responses from high rate overlapping pattern electroretinograms by deconvolution

OBJECTIVE

Due to overlapping, temporal information is mostly lost in high rate steady-state pattern electroretinograms (PERGSS). This study develops a deconvolution method and a display/recording system to "unwrap" PERGSS and obtain a transient, "per stimulus" response (PERGtr) regardless of reversal rate.

METHODS

Processing and instrumentation, including high temporal resolution display and acquisition were developed for deconvolving PERGs acquired at high rates by slight jittering of reversal onsets at a given mean rate.

RESULTS

The system was successfully tested at eight rates from 2.2 to 78.1rps. At medium rates (17.4-41.2rps) recordings with conventional morphology (N35-P50-N95) but earlier peaks and higher amplitudes were extracted up to 40rps. At higher rates, smaller triphasic responses were obtained, exhibiting similar peak latencies, but reversed polarity. Oscillating potentials (OPs) were also recorded at all rates after deconvolution.

CONCLUSIONS

Transient PERGs and OPs can be extracted from quasi steady-state PERG recordings obtained at high rates with a deconvolution algorithm using high temporal resolution display and acquisition systems.

SIGNIFICANCE

The methodology to extract transient and oscillatory responses from steady-state PERGs could be useful in understanding high rate responses and diagnosis of various retinal diseases by revealing temporal information on waveform components which cannot be normally observed.