Auditory Late Responses (ALR) Flashcards

Question

Is repeatability the most important consideration for waveform analysis?

Answer 1

Major ALRs waves are probably wave complexes - each wave may include more than one individual component, which may arise from different neural sources Wave N1 is often well-defined with a relatively sharp peak P2 may be broad with multiple peaks in normal subjects For normal individuals, ALRs amplitude, morphology, and latency vary considerably; variations in part due to fluctuations in subject state For example, waveform morphology may be different if subject is awake and alert vs. awake but drowsy

Answer 2

Effects of sleep Age because of attention/neuromaturation effects

Answer 3

Reduction in amplitude Polarity reversal for selected components Total absence of one or more components Prolonged latency - because of inherent variability in normal responses, the strict criterion used for shorter latency responses (e.g., ABR) is not appropriate for ALRs Absent N1-P2 component

Answer 4

Yes N1-P2 or the N1 component P2-N2 or the N2 component

Answer 5

N1-P2 peak amplitude measurement is ~10.7 μV P2 amplitude ~7 μV

Answer 6

Yes, unlike latency Like the ABR, amplitude decreases with decreasing intensity But latency remains stable at > 20 dB SL re: threshold The P1-N1-P2 complex is often detected down to 10 dB nHL As intensity decreases to 10 to 15 dB SL re: threshold - P2 is no longer seen and N1 then becomes the lowest observable response

Answer 7

Yes Pervasive neural slowing with increased age may account for these deficits These responses also may be affected by decreased cognitive function They won't be getting the best benefit Learning curves of older adults did not maintain the younger adults rate of improvement when listening to speech in noise - presumably because of changes in cognitive function Why older adults still struggle to hear in noise

Answer 8

Yes Slow-acting compression algorithms in HAs maybe more appropriate for older adults with cognitive decline and/or slower neural processing To achieve adequate speech understanding in difficult listening environments, older adults may require greater auditory training, use of assistive listening devices

Answer 9

The primary auditory cortex and the cortical-cochlear loops P1 changes with age so it is an auditory biomarker of the developing auditory system post-exposure to sound You can monitor how the P1 is maturing with sound exposure Children implanted at < 3-years showed normal P1 responses within 3 to 6 months - early implantation is better About half the children implanted at 3.5 to 6.5 years showed normal P1 responses - will get some benefits, but may not get as much as the younger kids All the children implanted after 7-years showed abnormal P1 responses - the CI is not going to be very useful for that child

Answer 10

In the first 3.5 years of life During this time the human auditory cortex is maximally plastic Between 3.5 and 7 years, the degree of auditory plasticity is variable across children Beyond 7 years auditory plasticity is greatly reduced

Answer 11

Not only does the ALR P1 not reach normal latencies but the morphology of the waveform of the later developing ALR N1-P2 component is also affected in the long term In young children with little or no prior auditory experience, the ALR waveform is often characterized by a deep negativity - deprivation negativity (deprivation of sound) The deprivation negativity is the hallmark of an un-stimulated or little-stimulated, yet plastic central auditory pathway

Answer 12

Improvements for sound blending and auditory processing The N2 latency showed significant decreased (maturation) P2-N2 amplitude showed significant increase in noise post-training *done with Earobics *no pre vs post treatment change was noted for the ABR (this is expected due to it being at the brainstem level)

Answer 13

Yes These changes are associated with improvement in academic performance as well

Answer 14

Yes Conversely, they report on another case where three months of HA use showed no change in the P1 response indicating that amplification was insufficient for normal development of auditory pathways Authors report that combined with a standard hearing test battery, the P1 latency can play a useful role in determining the effectiveness of intervention strategies for children with hearing impairment

Answer 15

Compare the child to themselves with HA vs with CIs This is the challenge routinely encountered in clinic when using AERs as measure for diagnosis and intervention for (C)APD

Answer 16

No, only modest differenced between pre-and post-training

Answer 17

Yes This makes it difficult to determine if CAPD is present or if something else is playing a part

Answer 18

Cannot distinguish between ADHD, CAPD, and learning disabilities Many of the published studies, therefore, may be examining a heterogeneous group of children with LD, ADHD, and/or language issues rather than those with auditory specific processing deficits

Answer 19

Yes The question that needs to be asked if how severe the dysynchrony is rather than how severe the hearing loss is Hearing loss is variable with ANSD and not a good guide to severity of the dys-synchrony

Answer 20

Yes Children who showed a normal or delayed P1 had some dys-synchrony - these children would benefit from HAs Children who had abnormal or absent P1 had greater dys-synchrony - these children did not benefit from HAs, these children would probably benefit from a CI (can also show no change after amplification) *do MRI to make the child has an VIIIth nerve before diagnosing

Answer 21

CIs Need to have a good VIIIth nerve - and needs to be functional Synaptic or spiral ganglion problem - CI is able to bypass this dysynchrony

Answer 22

Yes Children implanted before 2 years showed a better P1 response than children implanted after 2 years *typical optimal age for implantation is 6.5 years (for children who are congenitally deaf)

Answer 23

A severe, chronic, and generally disabling cognitive and behavioral disorder It is a psychosis - a type of illness that causes severe mental disturbances that disrupt normal thoughts, speech, and behavior Caused by a combination of genetic and environmental factors (occurs in about 1% of the population, but in 10% of those with a first-degree relative) Disordered cognition is considered the core symptoms, which makes ALR a good tool to assess these patients

Answer 24

Hallucinations (see, hear (primarily voices), smell, or feel) Delusions (false beliefs that are illogical or not art of the culture) Blunted or flat affect and emotional withdrawal Motor retardation (may sit for hours without moving or talking)

Answer 25

A decrease in N1 amplitude with a modest increase in latency As comparison, epilepsy patients showed no change in amplitude of N1 when compared to patients with schizophrenia Suppression of S2 or sensory gating does not occur in patients who have schizophrenia suggesting a subcortical dysfunction of the thalamus in this population (scattered ability to attend)

Answer 26

Audiology graduate students typically receive little formal classroom or practicum instruction in the measurement and analysis of ALRs Although there is a rather large literature on the topic, the majority of papers are published in scientific journals read by psychologists or physiologists, rather than audiologists (we don't have a good grasp of what is going on) The gap between the research laboratory and the audiology clinic is large and it appears not many scientists or clinicians are willing to make the jump The variability within normal individuals make ALRs a less useful clinical tool Billing code for cortical evoked responses was purged long ago from the CPT manual, presumably for lack of use (got rid of it because it wasn't being used)

Auditory Late Responses (ALR) Flashcards

(54 cards)