Braz J Otorhinolaryngol. 2015;81(2):126---132
Brazilian Journal of
OTORHINOLARYNGOLOGY www.bjorl.org
ORIGINAL ARTICLE
P300 in individuals with sensorineural hearing loss夽 Ana Cláudia Mirandola Barbosa Reis a,∗ , Ana Claudia Figueiredo Frizzo b , Myriam de Lima Isaac a , Cristiane Fregonesi Dutra Garcia c , Carolina Araújo Rodrigues Funayama a , Maria Cecília Martinelli Iório d a
Faculdade de Medicina de Ribeirão Preto (FM-RP), Universidade de São Paulo (USP), São Paulo, SP, Brazil Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil c Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil d Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil b
Received 9 October 2013; accepted 22 March 2014 Available online 18 October 2014
KEYWORDS Event-related potentials, P300; Electrophysiology; Auditory evoked potentials; Hearing loss; Auditory cortex
Abstract Introduction: Behavioral and electrophysiological auditory evaluations contribute to the understanding of the auditory system and of the process of intervention. Objective: To study P300 in subjects with severe or profound sensorineural hearing loss. Methods: This was a descriptive cross-sectional prospective study. It included 29 individuals of both genders with severe or profound sensorineural hearing loss without other type of disorders, aged 11 to 42 years; all were assessed by behavioral audiological evaluation and auditory evoked potentials. Results: A recording of the P3 wave was obtained in 17 individuals, with a mean latency of 326.97 ms and mean amplitude of 3.76 V. There were significant differences in latency in relation to age and in amplitude according to degree of hearing loss. There was a statistically significant association of the P300 results with the degrees of hearing loss (p = 0.04), with the predominant auditory communication channels (p < 0.0001), and with time of hearing loss. Conclusions: P300 can be recorded in individuals with severe and profound congenital sensorineural hearing loss; it may contribute to the understanding of cortical development and is a good predictor of the early intervention outcome. © 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
夽 Please cite this article as: Reis AC, Frizzo AC, Isaac ML, Garcia CF, Funayama CA, Iório MC. P300 in individuals with sensorineural hearing loss. Braz J Otorhinolaryngol. 2015;81:126---32. ∗ Corresponding author. E-mail: [email protected] (A.C.M.B. Reis).
http://dx.doi.org/10.1016/j.bjorl.2014.10.001 1808-8694/© 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
P300 in individuals with sensorineural hearing loss
PALAVRAS-CHAVE Potencial evocado P300; Eletrofisiologia; Potenciais evocados auditivos; Perda auditiva; Córtex auditivo
127
P300 em indivíduos com perda auditiva sensorioneural Resumo Introduc¸ão: As avaliac ¸ões comportamentais e eletrofisiológicas auditivas contribuem para o entendimento do sistema auditivo e do processo de intervenc ¸ão. Objetivo: Estudar P300 em indivíduos com perda auditiva sensorioneural severa ou profunda. Método: Estudo prospectivo transversal descritivo. Participaram 29 indivíduos, de ambos os sexos, com idade entre 18 e 45 anos com perda auditiva sensorioneural, congênita severa ou profunda e sem comorbidades, avaliados por meio de avaliac ¸ão audiológica comportamental e potencial evocado auditivo de longa latência. Resultados: o registro da onda P3 foi obtido em 17 indivíduos, com latência e amplitude média de 326,97ms e 3,76V, respectivamente. Houve diferenc ¸as significativas da medida de latência em relac ¸ão à idade e da amplitude segundo o grau da perda auditiva. Evidenciou-se associac ¸ão ¸ão auditiva do resultado do P300 aos graus de perda auditiva (p=0,04) e ao canal de comunicac predominante (p=0,0001) e ao tempo de privac ¸ão auditiva (teste exato de Fisher). Conclusões: P300 pode ser registrado em indivíduos com perda auditiva sensorioneural congênita e colaborar para a compreensão do desenvolvimento cortical auditivo e ser preditor do resultado da intervenc ¸ão. © 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.
Introduction There is a long history of investigation of the function of the auditory system, the disorders that affect it and intervention strategies to mitigate the ill effects of those disorders. Increasingly, investigators have studied the peripheral and central auditory system using objective and non-invasive techniques, such as behavioral tests that assess auditory processing, as well as electrophysiological evaluation, principally auditory evoked potentials (AEPs).1---10 The auditory event-related evoked potential (P300) provides an objective measure of central auditory function, as it reflects the cortical electrophysiological activity involved in attention, discrimination, memory, integration, and decision-making skills.11 The few reports in the literature that have recorded cortical auditory event-related evoked potentials (P300) in individuals with hearing loss frequently consist of only a small number of individuals, and these studies have reported divergent results. Peripheral hearing loss can indirectly affect recordings of the latency of the P3 and the N1---P2---N2 complex. Another factor that impacts the results of P300 recordings is a difference in hearing thresholds at two frequencies, commonly observed in the elderly and in hearing loss with a descending pattern.12 However, a peripheral hearing loss does not invalidate the use of this measure, as long as the individual is capable of perceiving the stimulus.13 Latency measures are known to be sensitive indicators in individuals with hearing loss and the degree of hearing loss can affect the amplitudes of the components of auditory evoked potentials (AEPs) in different ways. Age can also influence latency measures, as can other factors. Values close to 350 ms are considered normal for the P300 latency in adults younger than 45 years of age;
after that age, it has been proposed to add 10 ms for each decade of life.14---16 The aim of this study was to investigate the auditory evoked potential P300 in individuals with severe to profound congenital hearing loss and to correlate the results with age, gender, degree of hearing loss, time of auditory deprivation, and the predominant communication modality (auditory or visual).
Methods This was a descriptive, contemporary, cross-sectional cohort study. The study was approved by the research ethics committee of a public university in the state of São Paulo --- SP (protocol #1011/01). All participants or guardians received an invitation letter with information about the study and signed the informed consent. A total of 29 individuals (15 males and 14 females), between the ages of 18 and 45 years, participated in the study. The inclusion criteria were: adult subjects of both genders, aged 18---45 years, with, bilateral, symmetric, prelingual, severe-to-profound sensorineural hearing loss, exhibiting hearing thresholds between 70 and 90 dBHL in at least two frequencies in both ears and with no other disorders or evidence of central auditory hearing impairment. Initially, a review of the medical records and a structured interview were performed to obtain personal data related to the subject’s history and type of rehabilitation. Behavioral, audiological, and impedance assessments were performed to ensure the subjects’ eligibility. Electrophysiological assessment was performed using the long-latency auditory evoked potential (P300) recording. Bio-logic Systems Corp. equipment was used for the P300 recording. The active electrodes were placed on the forehead (Fpz = ground electrode), the cranial vertex (Cz = active
128 Table 1
Reis AC et al. Descriptive analysis of amplitude (V) and latency (ms) of P300 according to gender. Latency (ms) Male
Mean Median SD SE p (paired Student’s t-test)
Amplitude (V) Female
Male
Female
CzA2
CzA1
CzA2
CzA1
CzA2
CzA1
CzA2
CzA1
331.9 341.0 45.85 15.28
325.4 324.0 42.96 14.32
322.9 321.0 41.14 14.54
327.3 319.0 34.61 12.24
4.45 3.18 3.14 1.05
4.35 3.22 2.34 0.78
2.77 2.60 1.40 0.50
3.29 2.93 1.26 0.45
0.45
electrode), and the earlobes (reference electrode: A1 = LE and A2 = RE), according to the International 10-20 System,17 and headphones were used (TDH-39). For the electrophysiological assessment, we required that each electrode have an impedance ≤3 k and the impedance between electrode pairs was
Brazilian Journal of
OTORHINOLARYNGOLOGY www.bjorl.org
ORIGINAL ARTICLE
P300 in individuals with sensorineural hearing loss夽 Ana Cláudia Mirandola Barbosa Reis a,∗ , Ana Claudia Figueiredo Frizzo b , Myriam de Lima Isaac a , Cristiane Fregonesi Dutra Garcia c , Carolina Araújo Rodrigues Funayama a , Maria Cecília Martinelli Iório d a
Faculdade de Medicina de Ribeirão Preto (FM-RP), Universidade de São Paulo (USP), São Paulo, SP, Brazil Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil c Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil d Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil b
Received 9 October 2013; accepted 22 March 2014 Available online 18 October 2014
KEYWORDS Event-related potentials, P300; Electrophysiology; Auditory evoked potentials; Hearing loss; Auditory cortex
Abstract Introduction: Behavioral and electrophysiological auditory evaluations contribute to the understanding of the auditory system and of the process of intervention. Objective: To study P300 in subjects with severe or profound sensorineural hearing loss. Methods: This was a descriptive cross-sectional prospective study. It included 29 individuals of both genders with severe or profound sensorineural hearing loss without other type of disorders, aged 11 to 42 years; all were assessed by behavioral audiological evaluation and auditory evoked potentials. Results: A recording of the P3 wave was obtained in 17 individuals, with a mean latency of 326.97 ms and mean amplitude of 3.76 V. There were significant differences in latency in relation to age and in amplitude according to degree of hearing loss. There was a statistically significant association of the P300 results with the degrees of hearing loss (p = 0.04), with the predominant auditory communication channels (p < 0.0001), and with time of hearing loss. Conclusions: P300 can be recorded in individuals with severe and profound congenital sensorineural hearing loss; it may contribute to the understanding of cortical development and is a good predictor of the early intervention outcome. © 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
夽 Please cite this article as: Reis AC, Frizzo AC, Isaac ML, Garcia CF, Funayama CA, Iório MC. P300 in individuals with sensorineural hearing loss. Braz J Otorhinolaryngol. 2015;81:126---32. ∗ Corresponding author. E-mail: [email protected] (A.C.M.B. Reis).
http://dx.doi.org/10.1016/j.bjorl.2014.10.001 1808-8694/© 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
P300 in individuals with sensorineural hearing loss
PALAVRAS-CHAVE Potencial evocado P300; Eletrofisiologia; Potenciais evocados auditivos; Perda auditiva; Córtex auditivo
127
P300 em indivíduos com perda auditiva sensorioneural Resumo Introduc¸ão: As avaliac ¸ões comportamentais e eletrofisiológicas auditivas contribuem para o entendimento do sistema auditivo e do processo de intervenc ¸ão. Objetivo: Estudar P300 em indivíduos com perda auditiva sensorioneural severa ou profunda. Método: Estudo prospectivo transversal descritivo. Participaram 29 indivíduos, de ambos os sexos, com idade entre 18 e 45 anos com perda auditiva sensorioneural, congênita severa ou profunda e sem comorbidades, avaliados por meio de avaliac ¸ão audiológica comportamental e potencial evocado auditivo de longa latência. Resultados: o registro da onda P3 foi obtido em 17 indivíduos, com latência e amplitude média de 326,97ms e 3,76V, respectivamente. Houve diferenc ¸as significativas da medida de latência em relac ¸ão à idade e da amplitude segundo o grau da perda auditiva. Evidenciou-se associac ¸ão ¸ão auditiva do resultado do P300 aos graus de perda auditiva (p=0,04) e ao canal de comunicac predominante (p=0,0001) e ao tempo de privac ¸ão auditiva (teste exato de Fisher). Conclusões: P300 pode ser registrado em indivíduos com perda auditiva sensorioneural congênita e colaborar para a compreensão do desenvolvimento cortical auditivo e ser preditor do resultado da intervenc ¸ão. © 2014 Associac ¸ão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.
Introduction There is a long history of investigation of the function of the auditory system, the disorders that affect it and intervention strategies to mitigate the ill effects of those disorders. Increasingly, investigators have studied the peripheral and central auditory system using objective and non-invasive techniques, such as behavioral tests that assess auditory processing, as well as electrophysiological evaluation, principally auditory evoked potentials (AEPs).1---10 The auditory event-related evoked potential (P300) provides an objective measure of central auditory function, as it reflects the cortical electrophysiological activity involved in attention, discrimination, memory, integration, and decision-making skills.11 The few reports in the literature that have recorded cortical auditory event-related evoked potentials (P300) in individuals with hearing loss frequently consist of only a small number of individuals, and these studies have reported divergent results. Peripheral hearing loss can indirectly affect recordings of the latency of the P3 and the N1---P2---N2 complex. Another factor that impacts the results of P300 recordings is a difference in hearing thresholds at two frequencies, commonly observed in the elderly and in hearing loss with a descending pattern.12 However, a peripheral hearing loss does not invalidate the use of this measure, as long as the individual is capable of perceiving the stimulus.13 Latency measures are known to be sensitive indicators in individuals with hearing loss and the degree of hearing loss can affect the amplitudes of the components of auditory evoked potentials (AEPs) in different ways. Age can also influence latency measures, as can other factors. Values close to 350 ms are considered normal for the P300 latency in adults younger than 45 years of age;
after that age, it has been proposed to add 10 ms for each decade of life.14---16 The aim of this study was to investigate the auditory evoked potential P300 in individuals with severe to profound congenital hearing loss and to correlate the results with age, gender, degree of hearing loss, time of auditory deprivation, and the predominant communication modality (auditory or visual).
Methods This was a descriptive, contemporary, cross-sectional cohort study. The study was approved by the research ethics committee of a public university in the state of São Paulo --- SP (protocol #1011/01). All participants or guardians received an invitation letter with information about the study and signed the informed consent. A total of 29 individuals (15 males and 14 females), between the ages of 18 and 45 years, participated in the study. The inclusion criteria were: adult subjects of both genders, aged 18---45 years, with, bilateral, symmetric, prelingual, severe-to-profound sensorineural hearing loss, exhibiting hearing thresholds between 70 and 90 dBHL in at least two frequencies in both ears and with no other disorders or evidence of central auditory hearing impairment. Initially, a review of the medical records and a structured interview were performed to obtain personal data related to the subject’s history and type of rehabilitation. Behavioral, audiological, and impedance assessments were performed to ensure the subjects’ eligibility. Electrophysiological assessment was performed using the long-latency auditory evoked potential (P300) recording. Bio-logic Systems Corp. equipment was used for the P300 recording. The active electrodes were placed on the forehead (Fpz = ground electrode), the cranial vertex (Cz = active
128 Table 1
Reis AC et al. Descriptive analysis of amplitude (V) and latency (ms) of P300 according to gender. Latency (ms) Male
Mean Median SD SE p (paired Student’s t-test)
Amplitude (V) Female
Male
Female
CzA2
CzA1
CzA2
CzA1
CzA2
CzA1
CzA2
CzA1
331.9 341.0 45.85 15.28
325.4 324.0 42.96 14.32
322.9 321.0 41.14 14.54
327.3 319.0 34.61 12.24
4.45 3.18 3.14 1.05
4.35 3.22 2.34 0.78
2.77 2.60 1.40 0.50
3.29 2.93 1.26 0.45
0.45
electrode), and the earlobes (reference electrode: A1 = LE and A2 = RE), according to the International 10-20 System,17 and headphones were used (TDH-39). For the electrophysiological assessment, we required that each electrode have an impedance ≤3 k and the impedance between electrode pairs was
