ORIGINAL ARTICLE
THE HEARLAB CORTICAL TONE EVALUATION (CTE) PROTOCOL: A CLINICAL FEASIBILITY STUDY
Ahmad A. Alanazi 1, 2, 3  
,   Nannette Nicholson 1, 2,   Samuel R. Atcherson 1, 2,   Patti Martin 4
 
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1
Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2
Department of Audiology and Speech Pathology, University of Arkansas at Little Rock, Little Rock, AR, USA
3
Department of Audiology and Speech Pathology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
4
Department of Audiology and Speech Pathology, Arkansas Children's Hospital, Little Rock, AR, USA
CORRESPONDING AUTHOR
Ahmad A. Alanazi   

Ahmad A. Alanazi, Department of Audiology and Speech Pathology, University of Arkansas at Little Rock, 2801 South University Ave., Little Rock, AR 72204, USA, e-mail: aalanazi@uams.edu
Publication date: 2016-09-30
 
J Hear Sci 2016;6(3):54–62
 
KEYWORDS
ABSTRACT
Background:
Cortical auditory evoked potentials (CAEPs) have been shown to demonstrate high correlations with pure-tone behavioral thresholds when using research protocols. However, experience using the HEARLab cortical tone evaluation (CTE) procedure clinically in sites independent of the National Acoustic Laboratories (NAL) remains limited. This study aimed to assess the clinical feasibility of the CTE protocol using the HEARLab system to estimate pure-tone behavioral thresholds at 500, 1000, 2000, and 4000 Hz.

Material and Methods:
This is a preliminary prospective study designed to compare behavioral hearing thresholds with air conduction CTE of 12 adults (8 with normal hearing and 4 with sensorineural hearing loss). A cortical auditory evoked potential (CAEP) threshold protocol was modeled after an existing auditory brainstem response (ABR) protocol used in-house. A t-test was used to identify differences between pure-tone behavioral thresholds and CTE thresholds.

Results:
Depending on frequency and intensity, CTEs varied from pure-tone behavioral thresholds by as much as 11.2 dB. The average test time to obtain CTEs at four frequencies per ear for 12 participants was 50.85 minutes (SD=12.0). Implications for inter-test reliability of the CTE protocol are discussed.

Conclusions:
The HEARLab CTE protocol is feasible for predicting pure-tone behavioral thresholds in those with normal hearing or with hearing loss. The CTE procedure is a useful alternative tool when behavioral threshold testing is neither possible nor practical.

 
REFERENCES (30)
1.
Durnate AS, Wieselberg MB, Roque N, Carvalho S, Pucci B, Gudayol N, de Almeida K. Assessment of hearing threshold in adults with hearing loss using an automated system of cortical auditory evoked potential detection. Braz J Otorhinolaryngol, 2016; 16: 1–8.
 
2.
Hall, JW. New Handbook of Auditory Evoked Responses. Boston, MA: Pearson, Allyn and Bacon; 2007.
 
3.
Dillon H. So, baby, how does it sound? Cortical assessment of infants with hearing loss. Hearing Journal, 2005; 58(10): 10–17.
 
4.
Lightfoot G, Kennedy V. Cortical electric response audiometry hearing threshold estimation: Accuracy, speed, and the effects of stimulus presentation features. Ear Hear, 2006; 27(5): 443–56.
 
5.
Yeung KNK, Wong LLN. Prediction of hearing thresholds: Comparison of cortical evoked response audiometry and auditory steady state response audiometry techniques. Int J Audiol, 2007; 46: 17–25.
 
6.
Hyde M. The N1 response and its applications. Audiol Neurotol, 1997; 2: 281–307.
 
7.
Tus B, Wong LLN, Wong ECM. Accuracy of cortical evoked response audiometry in the identification of non-organic hearing loss. Int J Audiol, 2002; 41: 330–33.
 
8.
Billings CJ, Tremblay KL, Miller CW. Aided cortical auditory evoked potentials in response to changes in hearing aid gain. Int J Audiol, 2011; 50(7): 459–67.
 
9.
Carter L, Dillon H, Seymour J, Seeto M, Van Dun B. Cortical auditory-evoked potentials (CAEPs) in adults in response to filtered speech stimuli. J Am Acad Audiol, 2013; 24: 807–22.
 
10.
Sharma A, Dorman MF, Spahr AJ. A sensitive period for the development of the central auditory system in children with cochlear implants: Implications for age of implantation. Ear Hear, 2002; 23(6): 532–39.
 
11.
Wunderlich JL, Cone-Wesson BK, Shepherd R. Maturation of the cortical auditory evoked potential in infants and young children. Hear Res, 2006; 212(1–2): 185–202.
 
12.
Sussman E, Steinschneider M, Gumenyuk V, Grushko J, Lawson K. The maturation of human evoked brain potentials to sounds presented at different stimulus rates. Hear Res, 2008; 236(1–2): 61–79.
 
13.
Crowley KE, Colrain IM. A review of the evidence for P2 being an independent component process: Age, sleep and modality. Clin Neurophysiol, 2004; 115(4): 732–44.
 
14.
Golding M, Dillon H, Seymour J, Carter L. The detection of adult cortical auditory evoked potentials (CAEPs) using an automated statistic and visual detection. Int J Audiol, 2009; 48(12): 833–42.
 
15.
Atcherson SR, Gould HJ, Pousson MA, Prout TM. Long-term stability of N1 generators using low-resolution electromagnetic tomography. Brain Topogr, 2006; 19: 11–20.
 
16.
Martin B, Tremblay KL, Stapells, DR. Principles and applications of cortical auditory evoked potentials. In: Burkard R, Don M, Eggermont JJ, editors. Auditory Evoked Potentials: Basic principles and applications. Lippincott: Williams & Wilkins; 2007; 497–507.
 
17.
HEARLab System. Operator’s manual 2015. Retrieved from http://www.frye.com/wp/wp-cont....
 
18.
Prasher D, Mula M, Luxon L. Cortical evoked potential criteria in the objective assessment of auditory threshold: A comparison of noise induced hearing loss with Meniere’s disease. J Laryngol Otol, 1993; 107: 780–86.
 
19.
Van Dun B, Dillon H, Seeto M. Estimating hearing thresholds in hearing-impaired adults through objective detection of cortical auditory evoked potentials. J Am Acad Audiol, 2015; 26: 370–83.
 
20.
Grayson-Stadler: GSI AudioStar Pro. Two-channel clinical audiometer 2014. Retrieved from http://www.grason-stadler.com/....
 
21.
American Speech-Language-Hearing Association (ASHA). Guidelines for Manual Pure-Tone Threshold Audiometry 2004. Retrieved from http://www.asha.org/policy/GL2....
 
22.
Picton TW. Human Auditory Evoked Potentials. San Diego, CA: Plural Publishing Inc.; 2011.
 
23.
Albera R, Canal, G, Magnano M, Lacilla, M, Morra B, Rugiu MG, Cortesina G. Relations between pure-tone audiometry and cortical evoked auditory potentials. Acta Otorhinolaryngol Ital, 1991; 11: 551–62.
 
24.
Carter L, Golding M, Dillon H, Seymour J. The detection of infant cortical auditory evoked potentials (CAEPs) using statistical and visual detection techniques. J Am Acad Audiol, 2010; 21: 347–56.
 
25.
Munro KJ, Purdy SC, Ahmed S, Begum R, Dillon H. Obligatory cortical auditory evoked potential waveform detection and differentiation using a commercially available clinical system: HEARLab. Ear Hear, 2011; 32: 782–86.
 
26.
Van Maanen A, Stapells DR. Comparison of multiple auditory steady-state responses (80 versus 40 Hz) and slow cortical potentials for threshold estimation in hearing-impaired adults. Int J Audiol, 2005; 44(11): 613–24.
 
27.
Pearce W, Golding M, Dillon H. Cortical auditory evoked potentials in the assessment of auditory neuropathy. J Am Acad Audiol, 2007; 18(5): 380–89.
 
28.
Shuman H, Teagle HF, Rouch P, Grose J, Buchman C. Objective hearing threshold estimation in children with auditory neuropathy spectrum disorder. Laryngoscope, 2013; 123: 2859–61.
 
29.
Narne VK, Vanaja C. Speech identification and cortical potentials in individuals with auditory neuropathy. Behav Brain Funct, 2008; 31: 4–15.
 
30.
Durrant JD, Hyre R. Relative effective frequency response in bone versus air conduction stimulation examined via masking. Audiol J, 1993; 32: 175–184.