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Performance of Two Hemispherectomized Subjects on A PERFORMANCE OF TWO HEMISPHERECTOMIZED SUBJECTS ON A DICHOTIC BINAURAL FREQUENCY FUSION TEST BY ELIZABETH ANNE FEICK B.Sc, University of Toronto, 1972 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in the Department of Paediatrics Divison of Audiology and Speech Sciences We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA June 1974 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of OMO/J.^^W /into/ SsomJ-Sc. The University of British Columbia Vancouver 8, Canada i i ABSTRACT This study investigates the performance of two hemispherec- tomized subjects and ten normal subjects on a dichotic binaural frequency fusion (DBFF) test and on a competing dichotic message test. The DBFF test was designed to examine whether binaural integration of two complementary frequency segments of the same word, dichotically presented, necessitates the presence of two intact hemi• spheres. The competing dichotic message test was presented to provide a measure of the extent of strengthening of ipsilateral pathways in the hemispherectomized subjects. The DBFF test consisted of three fifty-word CNC lists which were processed through two band-pass filters and recorded on a two-- channel magnetic tape. The test consisted of two binaural conditions. In the Dichotic A condition, the high band was delivered to the left ear and the low band to the right. The Dichotic B condition was the reverse of the first. For each condition 50 phonetically balanced (PB) words were presented and the subject was required to repeat the word in a 4 second interval between words. The competing dichotic message test consisted of 15 sets of three pairs of words, one of each pair being presented simultan• eously to either ear, using stereophonic head-phones. The subject was required to repeat as many words from each set as possible. The Z scores, measuring the deviation in standard deviation units of the raw scores of the operated subjects from the mean scores iii of the normals indicated that the removal of a hemisphere did not significantly decrease the scores of two hemispherectomized subjects on a DBFF test. Removal of a hemisphere, however, decreased the scores of the hemispherectomees on the competing dichotic message test in one of the ears -- specifically the ear contralateral to the removed hemisphere. A comparative analysis of how the central auditory nervous system (CANS) of a hemispherectomized subject might process a complemen• tary dichotic message (exemplified by the DBFF test), as opposed to a competing dichotic message, provides an interesting basis for a dis• cussion on the nature of the "biological detector" of speech elements in the CANS. i v TABLE OF CONTENTS PAGE ABSTRACT ii TABLE OF CONTENTS iv LIST OF TABLES vi LIST OF FIGURES vii ACKNOWLEDGEMENT - .viii CHAPTER 1. INTRODUCTION "I 2. REVIEW OF LITERATURE 3 2.0 Introduction 3 2.1 The Auditory Pathways -3 2.2 Detection of Central Auditory Lesions 4 2.2.1 Distinguishing Brainstem Lesions from Temporal Lobe Lesions 4 2.2.2 Dichotic Binaural Frequency Fusion Tests 9 2.3 Functionality of the Ipsilateral Pathways .... 18 2.4 Prepotence of Contralateral Auditory Pathways over Ipsilateral Pathways 19 2.4.1 Electrophysiological Studies 19 2.4.2 The Intel!igibi11ity of Distorted Speech 20 2.4.3 Competing Dichotic Message Tests 20 2.5 The Development of Compensatory Mechanisms .... 22 2.6 Hemispherectomized Patients 28 v CHAPTER PAGE 3. AIMS OF THE EXPERIMENT 31 3.1 Statement of the Problem 31 3.2 Rationale 32 4. METHOD 35 4.1 General Outline 35 4.2 Preparation of Materials 36 4.3 Stimulus Words 38 4.4 Subjects 39 4.5 Pretest Conditions 41 4.6 Presentation of Materials 43 4.6.1 Calibration 43 4.6.2 Presentation of Pretest Conditions 43 4.6.3 Presentation of Dichotic A and Dichotic B Test Conditions 44 4.7 The Competing Dichotic Message Test 44 5. RESULTS 47 6. DISCUSSION 51 REFERENCES 61 APPENDIX 1 - List 1, List 2, and List 3 from the Northwestern University Test No. 6 64 APPENDIX 2 - Dichotically Presented Word Pairs 65 vi LIST OF TABLES TABLE PAGE 5.1 Scores Obtained on the Pretest, and on the Three Dichotic Listening Tests 48 5.2 Z Scores Indicating the Deviation in Standard Deviation Units of the Raw Scores of the Hemispherectomees from the Mean Scores of the Normals 49 vi i LIST OF FIGURES FIGURE PAGE 2.1 Diagrammatic Representation of Model 1 13 2.2 An Elaboration of Model 1 13 2.3 Diagrammatic Representation of Model 2 15 2.4 Diagrammatic Representation of the Auditory Path• ways Utilized when Words are Presented to the Left Ear of a Commissurotomized Subject 15 4.1 A Block Diagram of the Equipment Used for the Preparation of the DBFF Test s. 37 4.2 A Block Diagram of the Equipment Used for Presentation of the DBFF Test 45 ACKNOWLEDGEMENTS wish to thank all those who had a part in this the members of my thesis committee, Dr. John Delack, Dr. Juhn Wada, and especially, Dr. John Gilbert. all the subjects who participated. David Roberts who first told me about binaural integration. Margaret Roberts, Jim Pearse and Dr. Gannon for their cooperation in allowing me to use the facilities of the Audiovestibular Unit at VGH. Will, for his willing help in transporting equipment and subjects. Sharon, Lyn, Pat, Ingrid and Marilyn for their encouragement and good spirits. 1 CHAPTER 1 INTRODUCTION The rationale for a reliable audiological diagnostic test must ultimately rest on a sound knowledge of the functional organiza• tion of the auditory system. The understanding of the anatomy and physiology of the peripheral auditory system is at a relatively advanced stage. Pathologies accompanying disorders of the middle ear, the cochlea and the eighth nerve in the peripheral auditory system have been well delineated and effective audiological tests designed, which have proven reliably diagnostic in the localization of the site of the disorder. At a more germinal stage is the study of disorders of the- central auditory nervous system -- usually defined as that portion of the auditory system beyond the cochlear nuclei in the brainstem. The representation of the acoustic input to each ear in both hemispheres is realized by the projections of both contralateral and ipsilateral auditory pathways beyond the cochlear nuclei. The relative contributions of the ipsilateral and contralateral pathways, however, in the perception and discrimination of acoustic stimuli can be studied only in very special circumstances. Indeed, knowledge of the organization of the central auditory system is gleaned mainly by studying the defects in the perception of acoustic stimuli resulting from a pathological locus at some known level of the auditory system or by the surgical removal of a part of the system. 2 The case of a person who has undergone a complete unilateral hemispherectomy presents a special circumstance in which from each ear there is only one effective auditory pathway to the remaining hemisphere, the pathway from the contralateral ear containing a greater number of neuronal fibres than from the ipsilateral ear. Dichotic listening tests utilize the technique of simultaneous presentation of different acoustic stimuli to each ear. The messages in a dichotic listening test can be either (1) competing, as in the condition when a different word is presented simultaneously to either ear or (2) complementary — as when mutually exclusive frequency seg• ments of the same word are the acoustic stimuli. In a dichotic message presentation to a hemispherectomized subject there is only one destination a representation of each acoustic message must reach before a verbal report of the words is possible. Thus, the presentation of dichotic tests to a person who has undergone surgical removal of an entire hemisphere affords a unique opportunity to investigate the relative contributions of the ipsilateral and contralateral pathways in the processing and transmitting of complex acoustic stimuli to the intact hemisphere. The dangers inherent in using studies conducted solely on brain-damaged individuals to make generalizations concerning the functional organization of brain structures in the normal population are well recognized. It is, however, accepted that to shed some light on the mechanisms of auditory perception in man, researchers must still rely heavily on examination of the types of auditory analysis that can or cannot take place in the absence of auditory cortex. 3 CHAPTER 2 REVIEW OF LITERATURE 2.0 Introduction A survey of the literature pertinent to this research is presented in six sections. Section 2.1 describes the peripheral and central auditory pathways beyond the cochlea. Section 2.2 reviews audiological techniques which have been developed to aid in the diagnosis of central auditory lesions. Section 2.3 deals with the functionality of the ipsilateral pathways in the central auditory system and Section 2.4 reviews some of the research indicating that the contralateral auditory pathways are prepotent to the ipsilateral pathways. Section 2.5 discusses the ability of the nervous system of brain damaged individuals to develop compensatory mechanisms, while Section 2.6 discusses specifically the abilities of hemispherectomized patients. In this literature review and throughout the thesis, the words fusion and integration will be used interchangeably. 2.1 The Auditory Pathways Excitation of the hair cells of the cochlea causes electro- t h chemical stimulation of the afferent endings of the 8 nerve fibres whose bipolar cells are grouped together in the spiral ganglion.
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