Auditory Steady State Response ASSR

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

History
1970s: Basar et al. conducted first experiments on auditory SSEPs. 1981: Galambos et al. developed 40 Hz SSEP click response. 1982: Field Rickards patents the use of SSEPs with modulated puretones for hearing testing. 1982 Present: Cohen, Picton, Rickards, Stapells and others (independently) have continued research in the field of SSEPs. 1990s: ERA, Australia, starts development of KUNNAMPALLIL GEJO JOHN, BASLP, MASLP Commercial ASSR system

What is ASSR?
Steady-state evoked potential Periodic scalp potentials that arise in response to regularly varying stimuli such as a sinusoidal amplitude and/or frequency modulated tones.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Advantages of Steady State

Tones are continuous. Reduced spectral distortion problems associated with brief tone bursts or clicks. Stimulus as well as response are frequency specific Calibration corrections associated with tone bursts and clicks are not required Stimuli can be presented at levels as high as 120 dB HL
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Advantages of ASSR over ABR

Allows Objective frequency specific measurements (250 - 4 kHz in octave steps) Can use very loud stimuli (Up to 120 dBSPL)

Response is unaffected by sleep when using measurements with 70Hz modulation

More accurate estimation of behavioural threshold. (Within 5dB)
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

ASSR Vs Behavioural Thresholds

Frequency (Hz)
-10 0 10 20 30 40 50 60 70 80 90 100 110 125 250 500 1000 2000 4000

Hearing Threshold (dBHL)

Behavioural thresholds SSEP estimated thresholds

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Applications of ASSR
Fast Objective Estimation of Audiograms Infant Hearing Screening Hearing Aid Fitting for Infants Under 6 Months of Age

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Stimulus for ASSR

Any repetitive stimulation pattern may be created by using various methods: Repetition of a stimulus at a specific rate. Amplitude modulation of a continuous tone. Frequency modulation of a continuous tone. Amplitude and frequency modulation of a continuous tone. The stimulus may be presented continuously or in bursts of stimuli.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

A stimulus repetition is the most straight forward way of generating an ASSR. Any type of stimulus may be used: Clicks Pure Tones Frequency-Centered Tone Chirps

Because of the short duration of these signals, they may produce stronger responses as compared to amplitude and/or frequency modulated stimuli containing very long rise and fall times. KUNNAMPALLIL GEJO JOHN,
BASLP, MASLP

Amplitude Modulation

Frequency of an AM tone : Carrier frequency Rate of modulation : Modulating Frequency

BASLP, MASLP
KUNNAMPALLIL JOHN, Extent of modulation : GEJO Difference in CF and MF intensity

Extent of Amplitude Modulation

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Frequency Modulation

Frequencies in an FM tone : CF +/- MF Frequencies in an FM tone : Intensity of CF Rate of modulation : Modulating Frequency
KUNNAMPALLIL GEJO JOHN, Extent of modulation : CF - MF BASLP, MASLP

AM + FM

Combining both AM and FM has a dual effect on the cochlear generation site.
The time relationship between the maximum amplitude and maximum frequency is critical in eliciting optimal responses. These two should coincide in order to elicit the largest possible response.
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Generation of ASSRs
ASSR are the detectable potentials occurring in the Auditory Nerve, Brain Stem and Auditory Cortex in response to continuous, modulated single frequency sounds.
Generation site depends on the repetition or modulation rate.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Effect of Changing Frequency Modulation

20 - 40 Hz Modulation Responses originate in the

Cortex and Midbrain

70 Hz or greater Modulation Responses originate in the Brainstem

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

ASSR

Generation of ASSRs
Fast rate ASSRs are generated by the repetition of early and middle latency Auditory Evoked Potentials elicited by a stimulus train repeating at a rate >70 Hz .

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Acquisition Parameters
Gain: 10-100K High Pass Filter: 1 Hz Low Pass Filter: 300 Hz Acquisition Window: ~ 1000 ms Stimulus: Continuous or Long Duration Burst Click, 40 Hz Steady-State Responses can be measured with a variety of systems. Electrode Montage same as ABR Acquisition and analysis of frequency specific SteadyState Responses requires a specialized Steady-State evoked potential system and software.
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Basic concepts in ASSR analysis

1. SSEP is a deterministic signal. When a
stimulus is sufficient to evoke the SSEP, each sample will be identical (or repeatable). 2. Background noise is randomly distributed. The randomness of the noise can be described in statistical terms. 3. SSEP is independent of the background noise. The signal that is detected is thought of considering two parts, signal + background KUNNAMPALLIL noise. GEJO JOHN,
BASLP, MASLP

Analysis of ASSR
Time domain or Frequency domain.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Analysis contd.
SSEP is analyzed in the frequency domain, rather than the time domain. Fast Fourier Analysis reveals the EEG frequency that contribute to the response Frequency domain:

Amplitude information
Measured baseline to peak

Phase information
Measured as the cosine onset phase of the

recorded waveform

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Single Frequency ASSR

ASSR using 1000 Hz stimulus modulated at 80 Hz.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Responses at different intensities

dB SPL 60 50

40 30

20
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Phasor Diagram

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Phasor Diagram
The Phasor Diagram represents the amplitude and phase of the response measured at the repetition frequency. Unlike a spectral display, that shows amplitude information across all frequencies, the Phasor Diagram only represents one discrete frequency.
Depending on the response strength, the phasor amplitude and phase will vary KUNNAMPALLIL GEJO JOHN, BASLP, MASLP generating a circular distribution function.

Statistic methods: (a)F-Technique

Evaluates whether a response at the

frequency of stimulation is different from the noise at adjacent frequencies F-statistic: a ratio between the power at the signal frequency and the average power at the 120 neighboring frequency bins. The circle around the origin is the 95% confidence limit of the noise as evaluated by 120 FFT bins around the response.
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Statistic methods:
(b)T2-Technique To evaluate whether the two-dimensional response is replicable across the 16 sections that make up an average sweep. The circular 95% confidence limit of the mean of 16 different measurements is calculated. A response is considered present if the origin (zero) is not included within this confidence limit.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Multi frequency testing

By using various repetition rates or modulation frequencies, various carrier frequencies can be combined and tested simultaneously.

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Multifrequency stimulus
Each stimulus carrier frequency is modulated at a different modulation frequency

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Multifrequency response

Each carrier frequency will generate a response at the modulation frequency. Response determination is conducted as in the single frequency examples by measuring amplitude and phase for each frequency KUNNAMPALLIL at the corresponding modulation frequency. GEJO JOHN,
BASLP, MASLP

Response detection
Responses are detected by comparing the signal and noise characteristic at the modulation frequency and surrounding frequencies. Recordings are acquired using a split-buffer technique which allows comparison of signal and noise characteristics at each frequency. Using an F statistic, a response is determined to be present if the signal-to-noise ratio (SNR) is 6.13 dB (p=0.05) above the noise at the frequency bin corresponding to the repetition frequency and 5 Hz on either side. As the stimulus intensity of the carrier wave decreases, the amplitude of the phasor will also decrease and the phase distribution will widen. Below threshold levels, the phasors will have a random distribution near the center of the phasor graph.
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

Test stopping criteria

Residual Noise Measure

KUNNAMPALLIL GEJO JOHN, Response Detection

BASLP, MASLP

Response reporting

Audiogram SPL values may be converted to HL values using a conversion table or regression formulae.
GEJOthe JOHN, Audiograms may beKUNNAMPALLIL generated from ASSR responses in one or multiple BASLP, MASLP sessions .

Reporting : Phasor Diagram

A response phase analysis can be automatically generated showing how the response latency is affected by stimulation intensity as in an EP LatencyIntensity graph. KUNNAMPALLIL GEJO JOHN,
BASLP, MASLP

Sumary
ASSR is not a test for differential diagnosis. Its a test for establishing an approximate thresholds. An important advantage of ASSR is that it is a frequency specific,objective and less time consuming.
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP