title: Acoustically evoked auditory change complex in children with auditory neuropathy spectrum disorder: a potential objective tool for identifying cochlear implant candidates.
abstract: OBJECTIVE
  The overall aim of the study was to evaluate the feasibility of using electrophysiological measures of the auditory change complex (ACC) to identify candidates for cochlear implantation in children with auditory neuropathy spectrum disorder (ANSD). To achieve this overall aim, this study (1) assessed the feasibility of measuring the ACC evoked by temporal gaps in a group of children with ANSD across a wide age range and (2) investigated the association between gap detection thresholds (GDTs) measured by the ACC recordings and open-set speech-perception performance in these subjects.
  
  
  METHODS
  Nineteen children with bilateral ANSD ranging in age between 1.9 and 14.9 years (mean: 7.8 years) participated in this study. Electrophysiological recordings of the auditory event-related potential (ERP), including the onset ERP response and the ACC, were completed in all subjects and open-set speech perception was evaluated for a subgroup of 16 subjects. For the ERP recordings, the stimulus was a Gaussian noise presented through ER-3A insert earphones to the test ear. Two stimulation conditions were used. In the "control condition," the stimulus was an 800-msec Gaussian noise. In the "gapped condition," the stimuli were two noise segments, each being 400 msec in duration, separated by one of five gaps (i.e., 5, 10, 20, 50, or 100 msec). The interstimulation interval was 1200 msec. The aided open-set speech perception ability was assessed using the Phonetically Balanced Kindergarten (PBK) word lists presented at 60 dB SPL using recorded testing material in a sound booth. For speech perception tests, subjects wore their hearing aids at the settings recommended by their clinical audiologists. For a subgroup of five subjects, psychophysical GDTs for the Gaussian noise were also assessed using a three-interval, three-alternative forced-choice procedure.
  
  
  RESULTS
  Responses evoked by the onset of the Gaussian noise (i.e., onset responses) were recorded in all stimulation conditions from all subjects tested in this study. The presence/absence, peak latency and amplitude, and response width of the onset response did not correlate with aided PBK word scores. The objective GDTs measured with the ACC recordings from 17 subjects ranged from 10 to 100 msec. The ACC was not recorded from two subjects for any gap durations tested in this study. There was a robust negative correlation between objective GDTs and aided PBK word scores. In general, subjects with prolonged objective GDTs showed low-aided PBK word scores. GDTs measured using electrophysiological recordings of the ACC correlated well with those measured using psychophysical procedures in four of five subjects who were evaluated using both procedures.
  
  
  CONCLUSIONS
  The clinical application of the onset response in predicting open-set speech-perception ability is relatively limited in children with ANSD. The ACC recordings can be used to objectively evaluate temporal resolution abilities in children with ANSD having no severe comorbidities, and who are older than 1.9 years. The ACC can potentially be used as an objective tool to identify poor performers among children with ANSD using properly fit amplification, and who are thus, cochlear implant candidates.
authors.affiliation: 1Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; and 2Department of Otolaryngology-Ear, Nose & Throat, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Shuman
authors.initials: S
authors.lastname: He
authors.forename: John H
authors.initials: JH
authors.lastname: Grose
authors.forename: Holly F B
authors.initials: HF
authors.lastname: Teagle
authors.forename: Jennifer
authors.initials: J
authors.lastname: Woodard
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Park
authors.forename: Debora R
authors.initials: DR
authors.lastname: Hatch
authors.forename: Patricia
authors.initials: P
authors.lastname: Roush
authors.forename: Craig A
authors.initials: CA
authors.lastname: Buchman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods; D005072:Evoked Potentials, Auditory / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D006313:Hearing Loss, Central / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D013067:Speech Perception / Q000502:physiology