SLHS 588A Electrophysiologic Assessment Techniques: FALL Class Meeting: Room 229-SLHS, MW 2:00 to 3:15 p.m; Lab: TBA;

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1 1 SLHS 588A Electrophysiologic Assessment Techniques: FALL 2013 Barbara Cone-Wesson, Ph.D. 521 SLHS, Tel: Office hours: open door policy Class Meeting: Room 229-SLHS, MW 2:00 to 3:15 p.m; Lab: TBA; Course Overview: Students will participate in lecture, discussion, and labs regarding the use of otoacoustic emissions and auditory evoked potentials from the cochlea, auditory nerve and brainstem to assess the auditory system in infants, children and adults. Students will learn the theory and technique of auditory brainstem responses (ABR), auditory steady-state evoked responses (ASSR), electrocochleography (ECOG), as evoked by acoustic and electric stimuli. Students will also learn the theory and technique of evoked otoacoustic emissions in the evaluation of the cochlea and efferent (olivo-cochlear bundle) auditory system. There will be an emphasis on the neurophysiologic bases of auditory evoked potentials and otoacoustic emissions and the way they are applied in the clinic and in research. Understanding the acoustic and pathologic variables that can affect the latency, amplitude, and morphology of auditory evoked potentials and otoacoustic emissions is paramount. Signal processing and automatic detection algorithms will be discussed. Throughout the course, critical review of the existing literature will be required and synthesis of material regarding how audiologists can optimize their application of electrophysiologic measures in the clinic. The labs (588a/Lab) will give participants the opportunity to learn proper technique for obtaining high quality evoked potentials and otoacoustic emissions. Students will be assessed on the basis of the 3 written assignments/exams and a final examination. This class must be taken concurrently with 588A Lab. There will be no written exam for the independent-study/lab practicum, but there will be writing and practical assignments which must be completed on schedule to receive a passing grade. Learner Outcomes As a result of completing the assigned reading, attending lecture and participating in discussion and labs the learner will be able to: 1) Define the principles of signal processing for auditory evoked potentials. 2) Calculate the amount of amplification, number of averages, filtering requirements and the artifact reject levels needed to obtain the ABR, ASSR, CM-CAP, TEOAEs and DPOAEs. 3) Define the neural generators of the ABR, ASSR, CM-CAP, and of spontaneous and evoked OAE suppression effects.

2 2 4) Discuss the stimulus variables that affect the latency and amplitude of ABR, ASSR, CM-CAP, and evoked OAEs. 5) Discuss the subject-related variables, including subject state and age, that affect the latency and amplitude of the ABR, ASSR, CM-CAP, spontaneous and evoked OAEs. 6) Summarize the effect of hearing loss and nervous system pathology on the ABR, ASSR,CM-CAP, spontaneous and evoked OAEs and their suppression. 7) Analyze each of the evoked potentials and OAEs in the time or frequency domain, as appropriate. 8) Analyze, interpret and summarize the results of ABR, ASSR,CM-CAP, and evoked OAE tests. 9) Compose/prescribe ABR, ASSR, CM-CAP, and OAE test protocols that can be used clinically. 10) Critique the literature pertaining to clinical applications of ABR, CM-CAP, ASSR, OAE tests. 11) Perform, analyze, interpret and summarize an ABR, CM-CAP, ASSR, and OAE test on a normally-hearing adult. 12) Propose a research need for each of the evoked potentials pertaining to their clinical applications. Students and instructors will abide by the academic code of conduct that can be found at It is your responsibility to familiarize yourself with this policy and also the policy against threatening behavior by students: Accessibility and Accommodations: It is the University s goal that learning experiences be as accessible as possible. If you anticipate or experience physical or academic barriers based on disability, please let me know immediately so that we can discuss options. You are also welcome to contact Disability Resources ( ) to establish reasonable accommodations. Absences from Lecture or Lab Please notify me in advance if you need to be absent from lecture or lab. All holidays or special events observed by organized religions will be honored for those students who show affiliation with that particular religion, Absences pre- approved by the UA Dean of Students (or Dean s designee) will be honored.

3 3 Weighting of Assignments/Exams 3 written assignments during the semester= 20% each. Written Assignment Dates Mon Sept 30 Wed Oct 23 Wed Nov 20 Final Comprehensive Exam = 40% Tuesday 17 December, 3:30-5:30 p.m. The written assignments may be given as take-home assignments. Advance notice will be given when this occurs. Grading Scale: 95%-100%= A 86-94% = B 75-85% = C The required texts are: New Handbook of Auditory Evoked Responses (2007) James W. Hall, III. Pearson-Allyn and Bacon, Boston. Human Auditory Evoked Potentials (2011) Terence W. Picton. Plural Publishing, San Diego. Recommended texts are: Auditory Evoked Potentials: Basic Principles and Clinical Application. (2007) Robert Burkard, Manuel Don and Jos J. Eggermont (Eds). Lippincott Williams and Wilkins, Baltimore. Handbook of Clinical Audiology, 6 th Edition (2009). Jack Katz, Larry Medwetsky, Robert Burkard, and Linda Hood. Lippincott, Williams and Wilkins, Philadelphia Otoacoustic Emissions: Clinical Applications 3 rd Edition (2007) Martin S. Robinette & Theodore J. Glattke (Eds), Thieme, New York. The information contained in the course syllabus, other than the grade and absence policies, may be subject to change with reasonable advance notice, as deemed appropriate by the instructor.

4 4 Lecture and Lab Schedule Mon 26 Aug Assessment of prior knowledge. Review the syllabus and learning objectives. Organizational meeting to determine day/time for 588a-Lab. Brief history of AEP in the study of hearing and clinical audiology. Wed 28 Aug Signal Processing I: Bio-electric safety. Principles of signal averaging in the time and frequency domains Mon 2 Sept Labor Day, no class Wed 4 Sept Signal Processing II: Filters, amplifiers, artifact reject LAB 1: ABR acquisition hardware and software Mon 9 Sept ABR I: Neural Generators, neural substrates Wed 11 Sept ABR II: Normal click evoked response, effect of level Lab 2: click-evoked ABR latency intensity function and threshold Mon 16 Sept ABR III: stimulus calibration, psychophysics of clicks. Wed 18 SeptABR IV: : Non pathologic variables, gender, aging, montage, rise-time, rate, tone-bursts` Lab 3: Stimulus Calibration Mon 23 Sept: ABR V: Pathology: Effects of conductive and sensory hearing loss. Wed 25 Sept. ABR VI, Pathology: Effects of neural and retro-cochlear disorders. Lab 4: Toneburst ABR Mon 30 Sept Written Assignment 1 Wed 2 Oct ABR VII: Effects of Maturation Estimation of thresholds in infants and children, predicting the audiogram with tone evoked responses. Mon 7 Oct ABR VIII Automatic detection algorithms, Fsp, newborn hearing screening applications. Wed 9 Oct: ABR IX: Bone-conduction ABR Lab 5: Fsp; BC ABR

5 5 Mon 14 Oct. Case Interpretation Discussion Wed 16 Oct: Reporting ABR results Mon 21 Oct ASSR I Neural generators, stimulus-response characteristics Wed 23 October: Written Assignment 2 Mon 28 Oct: ASSR II Detection algorithms, phase coherence Wed 30 Oct ASSR III Multi-frequency techniques, comparison of methods. Clinical applications Lab 6 ASSR Mon 4 Nov ECOG I: Physiology of cochlear potentials: cochlear microphonic, summating potentials, compound action potential. Wed 6 Nov ECOG II: Stimulus-response characteristics, technical variables, effects of hearing loss.ecog III: Effects of hearing loss; ECOG and endolymphatic hydrops Lab 7 ECOG Mon 11 Nov Veteran s Day Wednesday 13 Nov Electrically Evoked AEPs: ECAP (NRT, NRI), E-ABR Mon 18 November OAE I, Origins and potential applications of OAE measurements. Wed 20 November: Written Assignment III Mon Nov 25: OAE II, SOAEs +TEOAEs Wed Nov 27: OAE III: DPOAEs Lab 8 DPOAEs +TEOAEs Mon 2 Dec: OAE IV: Suppression of OAEs Wed 4 Dec: OAE V; Differential Diagnosis/Pathology Lab 9 OAE suppression Monday 9 Dec: OAEs: screening in neonates, children Wednesday 11 Dec: Putting it all together: OAE/ABR/ASSR interpretation

6 6 Tuesday 17 December 3:30 5:30 p.m. Final Exam Assigned Reading Schedule: Mon 26 Aug Brief history of AEP in the study of hearing and clinical audiology. Hall Chapter 1 Picton Chapter 1 Katz Chapter 11 Burkard Chapter 1 Wed 28 Aug Signal Processing I: Bio-electric safety. Principles of signal averaging in the time and frequency domains Hall Chapter 3, pp Picton Chapter 2 Burkard Chapter 4 Wed 4 Sept Signal Processing II: Filters, amplifiers, artifact reject Hand out: Signal processing and analysis (Hyde) Hand out: Acquisition of ABR (Hood) Mon 9 Sept ABR I: Neural Generators, neural substrates Hand out- Neural Generators (Moller) Hall Chapter 2 Picton Chapter 4 Burkard Chapter 7, 16 Wed 11 Sept ABR II: Normal click evoked response, effect of level Picton Chapter 5 Hall Chapter 3, pp Burkard Chapter 3 Mon 16 Sept ABR III: stimulus calibration, psychophysics of clicks. Hall Chapter 6, pp Wed 18 Sept ABR IV: : Non pathologic variables, gender, aging, montage, rise-time, rate, tone-bursts

7 7 Hall Chapters 6 and 7 Picton Chapter 8 Burkard Chapter 11 Mon 23 Sept: ABR V: Pathology: Effects of conductive and sensory hearing loss. Hall Chapters 7, 9,Chapter 10 Burkard Chapter 12 Katz Chapter 14 Wed 25 Sept. ABR VI, Pathology: Effects of neural and retrocochlear disorders. Picton Chapter 14, 15 Hall Chapter 8, 10 Katz 13 Burkard 13,14 Wed 2 Oct ABR VII: Effects of Maturation Estimation of thresholds in infants and children, predicting the audiogram with tone evoked responses. Picton Chapter 13 Hall Chapter 9 Stapells (Hand out) Katz Chapter 14 Burkard Chapter 18 Mon 7 Oct ABR VIII Automatic detection algorithms, Fsp, newborn hearing screening applications. Picton Chapter 6 Hall Chapter 7 Burkard Chapter 5 Wed 9 Oct: ABR IX: Bone-conduction ABR Picton Chapter 13 Hall Chapter 6 Handouts Mon 14 Oct. ABR X: Case Interpretation Discussion Hall, Chapters 8, 9, 10 Wed 16 Oct: Reporting ABR results

8 8 Mon 21 Oct ASSR I Neural generators, stimulus-response characteristics Picton Chapter 10 Katz Chapter 15 Mon 28 Oct: ASSR II Detection algorithms, phase coherence Picton Chapter 3 Burkard Chapter 21 Wed 30 Oct ASSR III Multi-frequency techniques, comparison of methods. Clinical applications Mon 4 Nov ECOG I: Physiology of cochlear potentials: cochlear microphonic, summating potentials, compound action potential. Hall, Chapters 4 and 5 Picton Chapter 7 Wed 6 Nov ECOG II: Stimulus-response characteristics, technical variables, effects of hearing loss.ecog III: Effects of hearing loss; ECOG and endolymphatic hydrops Katz Chapter 12 Burkard Chapter 9 Wednesday 13 Nov Electrically Evoked AEPs: ECAP (NRT, NRI), E-ABR Picton Chapter 16 Mon 18 November OAE I, Origins and potential applications of OAE measurements. Robinette & Glattke Chapters 1 and 2 Katz Chapter 21 Burkard Chapter 8 Mon Nov 25: OAE II, SOAEs +TEOAEs Robinette & Glattke, chapters 3 and 4 Wed Nov 27: OAE III: DPOAEs R+G Chapter5 Mon 2 Dec: OAE IV: Suppression of OAEs R+G Chapters 6,11

9 9 Wed 4 Dec: OAE V; Differential Diagnosis/Pathology R+G Chapters 7-9 Monday 9 Dec: OAEs: screening in neonates, children R+G Wednesday 11 Dec: Putting it all together: OAE/ABR/ASSR interpretation R+G Chapter 10 Katz Chapter 22