Rapid acquisition of the frequency-specific auditory brainstem response through parallel stimulus presentation

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Project Summary/Abstract The goal of this proposal is to develop a new kind of frequency-specific auditory brainstem response (ABR) exam—the parallel ABR (pABR)—which is designed to provide faster, more informative diagnoses. Measuring the ABR involves presenting brief sounds over a range of frequencies and intensities and recording the brain's response through electrodes placed on the head. Approximately 150,000 infants are referred for a diagnostic ABR exam each year in the United States. The results of this exam inform important clinical decisions that affect the child's long-term speech and language development. To ensure good recording quality in pediatric use, the test is performed while the patient sleeps. There are many measurements to make in a single exam, and if the patient wakes up early then the test is cut short, leading to incomplete diagnoses or the need to return for a second visit, which may result in attrition and delayed access to sound. In some patients it may be necessary to use sedatives or general anesthesia to ensure good measurements, but recent studies have found that early exposure to such drugs may damage the developing brain and cause cognitive problems later in childhood. Our preliminary data show that the pABR provides rapid measurement that could address traditional techniques' major shortcoming. In this project we will run experiments that test key aspects of the pABR which are essential to understand before its translation to the clinic. These experiments will be run in adult subjects for three reasons. First, it is a new technique whose feasibility needs to be demonstrated before testing in infants. Second, we will be able to determine the accuracy of the pABR by comparing its results to the behavioral tests of hearing loss that are possible in adults. Third, ABRs mature at a young age, making adults a reasonable model. In Aim 1 we will test the hypothesis that specific combinations of stimulus parameters (how fast they are presented and their intensity) will provide optimal signal-to-noise ratios and measurement times. In Aim 2 we will test the hypothesis that the pABR will accurately predict hearing thresholds and be faster in clinical use than traditional ABR. We will recruit people with hearing ranging from normal to severe loss. We will test pABR accuracy by comparing its threshold predictions to behavioral audiograms. We will test speed by comparing acquisition time of pABR to that of standard diagnostic ABR. In Aim 3 will test the hypothesis that the pABR provides cochlear place specific responses, particularly at high stimulus levels where these are hard to obtain due to spread of excitation. We will employ established methods using high-pass masking noise to determine this. Traditional ABR is an important and necessary diagnostic tool for pediatric audiology, but it carries significant time and financial cost. The aims of this project will answer basic questions about the pABR in adult subjects with normal hearing and with hearing loss. These studies will pave the way for the pABR's future translation, which would positively impact thousands of infants and children each year.