Electrocochleography
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J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.6.586 on 1 June 1976. Downloaded from Journal ofNeurology, Neurosurgery, andPsychiatry, 1976, 39, 586-592 Neurological applications of surface-recorded electrocochleography A. R. D. THORNTON AND C. H. HAWKES From the Audiology Group, Institute of Sound and Vibration Research, University of Southampton, and the Wessex Neurological Centre, Southampton General Hospital, Southampton SYNOPSIS A new outpatient technique, involving the recording of auditory-evoked responses from scalp electrodes, is described. Responses are obtained from the cochlea, cochlear nerve, and auditory brain stem nuclei. The effects of various disorders on these responses are illustrated and the procedure is assessed as a diagnostic technique. Electrocochleography is a technique that involves sensory potential, generated within the cochlea,Protected by copyright. the recording of small amplitude (<0.5 ,uV), which follows the time-history of the stimulus short latency (< 10 ms) auditory evoked pressure wave. The second response is the responses using time-domain averaging tech- cochlear nerve gross action potential (N1). niques to extract these small responses from the In 1967 Sohmer and Feinmesser reported the larger amplitude electrical activity caused by recording of the cochlear nerve response and a the ongoing electroencephalogram (EEG) and series of later responses using disc electrodes spontaneous myogenic potentials. The method placed on the skin surface. Figure 1 shows the most generally used is the transtympanic set of five neurogenic responses (N1 to NO) approach described by Ruben (1967) and by recorded from a normal subject. Lev and Sohmer Portmann and Aran (1971). This involves (1972) investigated the generating sites of these passing a needle electrode through the tympanum responses in the cat by a comparison of record- to make contact with the bony promontory. ings obtained from intracranial and from surface Two responses may be obtained from this electrodes. They concluded that the N1 response recording site. The first is the end-organ potential is generated at the cochlear nerve, N2 at the http://jnnp.bmj.com/ or cochlear microphonic (CM). This is a cochlear nucleus, N3 at the superior olive, and Pi P2 P3 P4 PS on September 25, 2021 by guest. I v \V , A-I I N1 N2 N3 N4 N5 FIG. 1 Cochlear nerve and brain stem evoked responses from a normal subject. The trailing edge of the inset pulse marks the time of acoustic stimulation. Normal responses: X axis- 15 ms/div. Y axis-32 n V/div. (Accepted 10 March 1976.) 586 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.6.586 on 1 June 1976. Downloaded from Neurological app.ications ofsurface-recorded electrocochleography 587 N4 and N5 at the inferior colliculus. Similar NORMATIVE DATA Normative data were obtained response complexes, recorded from humans, from six normal subjects who were tested four times have been described by Coles and Thornton at each of four stimulus levels. The response Terkildsen et al. (1973), and by Picton measurement parameters have been studied in detail (1973), (Thornton, 1975b) and it was concluded that, for et al. (1974). The possible application of these clinical purposes, the data are best represented by measures in the assessment of peripheral and the peak-to-peak amplitude, taken from a negative central neurological disorders has been described peak to the succeeding positive peak, and by the earlier (Thornton, 1975a). Here the neurological, latencies of the negative peaks. The statistical radiological, and audiological findings are properties of these response measures have also been compared with electrocochleographic results evaluated by Thornton (1975c), who showed that the in order to evaluate the use of this technique. normal values at each stimulus level may be ex- Four selected cases will be used to illustrate the pressed as a graph of response amplitude by latency findings. as shown in Fig. 2. Each ellipse corresponds to one of the responses N, to N5 and is centred on the mean METHOD values of amplitude and latency obtained from the The details of electrode derivation, test facilities, and normal subjects for that response. The ellipse itself experimental technique have been described earlier represents an equal probability contour that (Thornton, 1975b). Briefly, the patient lies on a bed corresponds to one standard deviation of latency in an electromagnetically screened anechoic room. on the horizontal axis and one standard deviation Silver-chlorided EEG disc electrodes are used and of amplitude on the vertical axis. Such a presentation the signals from the active electrodes at each mastoid provides a convenient format in which to assess the Protected by copyright. process are amplified, passed to the adjacent control values obtained from patients and to detect abnormal room, filtered, and fed to the analogue-to-digital changes in latency and in amplitude. Approximately converters of a PDP-12 computer. The computer 90 % of the results from normal subjects should lie carries out the averaging of 2000 stimulus presenta- within 1+ standard deviations from the mean value. tions in two channels with a 30 ms window. The It is realized that this small number of subjects averaged data are stored on digital magnetic tape will not provide definitive norms and, when the for subsequent retrieval and analysis. Click stimuli final details of the optimum recording parameters are presented via earphones or loudspeakers at a rate have been determined, larger numbers will be of 10/second and the test session lasts for about tested. However, these data do provide a preliminary 30 minutes. The patients are not sedated but are diagnostic baseline and allow an initial evaluation instructed to relax as much as possible. of this technique to be made. http://jnnp.bmj.com/ 500- 400-4cc- ,u 300- -v 0 0 on September 25, 2021 by guest. E 200- 100- 0 0 0 05 10 5 20 25 30 3-5 40 45 5*0 55 6-o0I 6-5 7-07 7-575 Latency (ms) FIG. 2 Normal values ofamplitude and latency shown as standard deviation ellipses for 80 dB sensation level. F J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.6.586 on 1 June 1976. Downloaded from 588 A. R. D. Thornton and C. H. Hawkes RESULTS ventriculogram showed symmetrical enlargement of the lateral and third ventricles; the aqueduct and CASE 1 DIAGNOSIS: CONGENITAL END-ORGAN DEAF- the fourth ventricle were displaced to the left and NEss A nine year old girl presented because of there was a slight forward shift of the aqueduct. At longstanding right-sided deafness and a six month history of rotary vertigo. Clinical examination operation a typical acoustic neuroma was found on the right side, expanding backwards into the cere- revealed a severe perceptive deafness in the right ear bellar hemisphere. but no other abnormality. Audiometrically there Electrocochleography was performed before was no measurable hearing in the affected ear. operation and the cochlear microphonic results are Electronystamography showed a first degree shown in Fig. 4. There are no appreciable nystagmus to the left and caloric testing revealed differences absent vestibular function on the right side. A diagnosis of right-sided end-organ dysfunction was made. The cochlear microphonic results, shown in Fig. 3, support this viewpoint. Binaural stimulation was used and the CM from the left side shows a reasonable reproduction of the stimulus waveform, whereas no similar response is visible in the record obtained simultaneously from the right side. L eft - ILeft / A Protected by copyright. .X. B FIG. 4 Cochlear microphonic responses obtained - I I I 1 i/ i i simultaneously from both sides from the patient with an acoustic neurofibroma. X axis: 90 ks/div. Y axis: 39 n V/div. in the amplitude or in the waveshape between the simultaneously recorded responses from the left and right sides. This implies that there remain some http://jnnp.bmj.com/ functional hair-cells and that the vascular supply to the cochlea is intact. The neurogenic responses, obtained with binaural stimulation and simultaneous FIG. 3 Cochlear microphonic (CM) responses from recording from left and right sides, are shown in the patient with end-organ hearing loss (AG2806). Fig. 5. The responses on the left side are all within Trace A: CM from the right affected side. Trace B: normal limits, as are the responses N2 to N5 (coch- lear nucleus to inferior colliculus) from the right. CM simultaneously recorded from the left unaffected on September 25, 2021 by guest. side. Trace C: Pressure waveform of the acoustic The right side N1 (cochlear nerve) response has a stimulus. Y axis: 20 n V/div. X axis: 58 ,ts/div. significantly smaller amplitude than normal. Thus, the cochlear microphonic measurements indicate normal end-organ function and the brain stem responses give normal values, leaving only the CASE 2 DIAGNOSIS: ACOUSTIC NEUROMA A fifty- abnormal cochlear nerve response, which implies four year old lady was admitted with a two month a lesion at this level. history of progressive headache, ataxia, dysarthria, and right-sided deafness. Neurological examination revealed papilloedema, nystagmus, severe perceptive CASE 3 DIAGNOSIS: PONTINE GLIOMA A seven year deafness on the right side, and truncal ataxia. A old boy was admitted with a six week history of J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.6.586 on 1 June 1976. Downloaded from Neutrological applications ofsurface-recorded electrocochleography59589 5cx9 4CO0 ra 300X- 0~ 0 0.5 1.0 15 2-0 2-5 3-0 3-5 4-0 4.5 5.0 5.5 60o 6.5 7-0 7-5 Latency (ins) FIG. 5 Cochlear nerve and brain stem response values from each side from the patient with a right side acoustic neurofibroma.