The auditory brainstem response is an evoked potential that can be clinically used to estimate hearing sensitivity and to identify auditory nervous system pathology. Recently, there has been an increase in the implementation of the CE-Chirp stimulus in AABR equipment for neonatal hearing screening. The purpose of this study is to evaluate the diagnostic accuracy of the LS CE-Chirp-evoked ABR compared to the traditionally used click-evoked ABR for the identification of different degrees and configurations of sensorineural (SNHL) hearing loss. An exploratory within-subject comparative research design was used. 49 ears with mild to moderate sensorineural hearing loss were assessed. Participants were assessed in a single session. Audiometric pure tone thresholds were obtained at 125-8000 Hz and ABR thresholds were measured using the click and LS CE-Chirp stimuli respectively. Click- and LS CE-Chirp-evoked thresholds were compared with each other and with behavioural pure tone average (PTA), high frequency average (HFA) and low frequency average (LFA). Diagnostic accuracy of the two ABR stimuli was also compared by using ROC curves. Differences between click- and LS CE Chirp-evoked ABR, and behavioural thresholds were not statistically significant (p>0.05). The strongest significant correlation for ABR using clicks to behavioural thresholds was found at 2000 and 4000 Hz, whereas, the strongest correlation for LS CE-Chirp ABRs to behavioural thresholds was found at 1000, 2000 and 4000 Hz (r>0.7, p<0.001). A very strong, positive correlation was found between both click (r=0.805) and LS CE-Chirp (r=0.825) and the behavioural PTA (p<0.001). The mean differences for LS CE-Chirp were smaller than those of the click for PTA and low frequency range. ROC curves indicated better AUC values for the LS CE-Chirp at LFA and HFA compared to the click, also showing a narrower confidence interval and less variance than the click. The predictive accuracy of the LS CE-Chirp-evoked ABR was slightly better than that of the click with reference to PTA, HFA and LFA thresholds; furthermore, it is less variable and more accurate than the click-evoked ABR with reference to HFA. Thus, the LS CE-Chirp is an accurate stimulus for estimation of hearing sensitivity using ABR when compared to the gold standard click stimulus for the purpose of identification of different configurations of SNHL. / Dissertation (MA Audiology) University of Pretoria, 2019. / Speech-Language Pathology and Audiology / MA (Audiology) / Unrestricted

This paper provides an overview of developmental timetables relevant to hearing and of current pediatric audiological techniques and practices. The first sections summarize structural and functional development of the auditory pathway and the development of primary auditory processing. These developmental sequences appear to follow similar paths in humans and animals. Speech and music perception involve more complex processing and are strongly influenced by experience. Hearing disorders affect the perception of complex sounds in a variety of ways, depending on the site(s) of lesions. Early onset hearing impairment, including conductive loss from chronic otitis media, can seriously impede language development. Language cannot develop normally without adequate speech stimulation. Sensitive and inexpensive techniques are available for performing neonatal hearing screening, and early intervention has a positive effect on development of language skills in hearing-impaired children. Thus, the National Institute of Health has recommended nationwide universal newborns hearing screening. The rationale and methodology of universal screening programs is summarized in the chapter. Advances in the field of the genetics of hearing impairment are also reviewed Recent advances in the field of auditory physiology - coupled with longstanding concerns about delayed identification of hearing impairment - have precipitated public health initiatives (National Institute of Health, 1993) and legislation for neonatal hearing screening programs (Blake & Hall, 1990). Pediatric audiology, once more “art” than science, is now largely based on physiologic methods rather than observed behavior. With current techniques, it is not only possible to detect hearing impairment at birth but also to determine the site of the lesion and to obtain close estimates of hearing threshold at specific frequencies (Werner, Folsom, & Mancl, 1993). Habilitative measures, including amplification, can begin within weeks of birth. Protocols for the management of hearing impairment are guided not only by the site of the lesion but by the developmental sequences and interactions among all of the child’s sensory modalities. This chapter provides an overview of developmental timetables relevant to hearing and of current pediatric audiological techniques and practices.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21010号 / 医博第4356号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 井上 治久, 教授 村井 俊哉, 教授 林 康紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第24797号 / 医博第4989号 / 新制||医||1066(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 花川 隆, 教授 髙橋 良輔, 教授 高橋 淳 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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<p>The superior olivary complex (SOC) is comprised of nuclei involved in sound localization. To compute interaural sound level differences, lateral superior olive (LSO) neurons integrate converging glutamatergic inputs from the cochlear nucleus with glycinergic inputs from the medial nucleus of the trapezoid body (MNTB). To compute interaural timing differences, the medial superior olive (MSO) integrates converging glutamatergic inputs from the ipsilateral and contralateral cochlear nucleus. The MSO also receives a major inhibitory input from the MNTB. N-methyl-D-aspartate receptors (NMDARs) are thought to play a role in the developmental refinement of these auditory brainstem pathways. The GluN2A and GluN2B NMDAR subunits confer widely different properties on NMDARs, substantially affecting plasticity. We assessed postnatal developmental messenger RNA (mRNA) expression of GluN1, GluN2A and GluN2B subunits in the LSO, MSO and MNTB using quantitative <em>in-situ</em> hybridization in tissue from 10 litters, ages postnatal day 1 to 36 (P1-36).</p> <p>GluN1 mRNA expression in the LSO, MSO and MNTB decreased with age. In all three nuclei, GluN2B mRNA expression was highest during the first postnatal week, dropping to low levels thereafter. In the LSO, GluN2A levels increased, then decreased to moderate levels. In the MNTB, GluN2A levels decreased from initially high levels. In the MSO, GluN2A levels increased to intermediate levels. The GluN2A/2B ratio increased 2-fold between P1 and P8 in the MNTB, whereas the ratio increased 3-fold between P8 and P15 in the LSO and MSO. The changes in GluN2A:GluN2B ratio are consistent with a developmental switch from GluN2B-containing NMDARs to GluN2A-containing NMDARs. These results are consistent with prior electrophysiological experiments that show NMDAR-mediated currents declining with age in the aVCN-MNTB, aVCN-LSO and MNTB-LSO pathways. The GluN2A subunit exhibited different developmental expression patterns in MNTB, LSO and MNTB, which suggests that GluN2A mRNA expression is locally regulated between nuclei, whereas GluN2B may be globally regulated.</p> / Master of Science (MSc)