Characteristics of cochlear microphonics in infants and young children with auditory neuropathy

Abstract

Conclusions: Cochlear microphonics (CMs) play an important role in the diagnosis of auditory neuropathy (AN). It is necessary and helpful to diagnose the sites-of-lesion in infants and children with AN by analyzing the patterns of CM amplitudes and I/O functions together. Objectives: To investigate the characteristics and clinical significance of CMs in the diagnosis of AN among infants and children. Methods: A total of 36 infants and children (16 males and 20 females) were divided into two groups. Group A included 15 children (30 ears) with auditory brainstem response (ABR) absent and distortion product otoacoustic emissions (DPOAEs) present and group B included 21 children (30 ears) with ABR absent and DPOAEs absent. Fifteen normal-hearing infants (30 ears) made up the control group. Click eliciting CMs were recorded at stimulus levels of 100, 90, 80, and 70 dB nHL for each ear using a button electrode placed at the top of the forehead. A tube-clamping method was used to distinguish CMs from artifacts, and an averaging algorithm was used to obtain a clear CM waveform. The time delay and amplitude of CMs were measured in both children with AN and normal-hearing infants on (C–R)/2 waveforms, and an I/O function curve for each group was plotted with the stimulating level as input and the CM amplitude as output. Results: The largest identifiable CMs were generally found between 0.5 and 0.8 ms after stimulation with mean delay of 0.63 ± 0.04 ms in both group A and the control group, and 0.63 ± 0.07 ms in group B. There was no significant difference between the AN group and the control group in CM time delay. There was no significant difference (p > 0.05) between group A (AN with OAEs present, 0.47 ± 0.15 μV) and the control group (0.45 ± 0.13 μV) in CM amplitude, while CM amplitudes in children with AN with DPOAEs absent (0.24 ± 0.08 μV) were significantly lower than those in either the control group or group A (p < 0.01). The amplitude of CMs reduced with stimulus intensity in all the subjects. There was obvious nonlinearity in group A and the control group, while there was a more linear tendency in amplitude increasing on the I/O function curve in group B.

Keywords::

• Cochlear microphonics
• auditory neuropathy
• vestibulocochlear nerve diseases
• evoked potentials
• auditory brainstem
• hearing loss

Acknowledgment

We thank the patients for their cooperation during this work. We also thank the technicians in the Clinical Auditory Medicine Centre at the Department of Otolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital for their technical support. This work was supported by grants from the National Natural Science Foundation of China, Key Program (grant nos 30830104 and 81120108009).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.