BIC Presentation Coco
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Transcript of BIC Presentation Coco
Binaural Interaction Component of the ABR in Veterans with Type 2 Diabetes
Laura Coco, B.A.1,2, Marilyn Dille, Ph.D.2, Garnett P. McMillan, Ph.D.2, Dawn Konrad-Martin, Ph.D. 2
(1) University of Texas at Austin, Austin TX (2) National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland OR
• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications • retinopathy• nephropathy• numbness in limbs• ataxia
Introduction
WHO, 2010; Austin et al 2009; Vaughn et al 2006; Miller et al 2004
• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Diaz de Leon-Morales et al., 2005; Frisina et al., 2006; Vaughn et al., 2006; Bainbridge et al.,
2008; Austin et al., 2009; Cheng et al., 2009; Mitchell et al., 2009; Bainbridge et al., 2011; Bamanie and Al-Noury, 2011; Lerman-Garber et al., 2012)
Introduction
Bainbridge 2008
• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Bainbridge et al. 2008; Dalton et al. 1998; Agrawal et al. 2009; Cullen & Cinnamond 1993; Lisowska et al. 2001, Frisina
et al. 2006; Vaughan et al. 2007; Austin et al. 2009)
• Central (Parving et al., 1990; Bayazit et al., 2000; Durmus et al., 2004; Diaz de Leon-Morales et al., 2005; Vaughn et al., 2007; Konrad-Martin et al., 2010)
Introduction
• Type 2 Diabetes Mellitus (DM) affects >8% of population
• Complications
• Hearing Loss and DM• Peripheral (Bainbridge et al. 2008; Dalton et al. 1998; Agrawal et al. 2009; Cullen & Cinnamond 1993; Lisowska et al. 2001, Frisina et al.
2006; Vaughan et al. 2007; Austin et al. 2009)
• Central (Diaz de Leon-Morales et al 2005; Vaughan et al 2007; Bayazit et al 2000; Konrad-Martin et al 2010)
Introduction
Konrad-Martin et al 2010
• Poor performance on speech in noise tasks
Diabetes and Hearing
Frisina et al 2006
• Sound localization• Separating noise from speech• Loudness summation• Redundancy/Comparison• Squelch
Binaural Hearing
How do we evaluate binaural hearing?
Behavioral tests: SSI, HINT, SPIN, WIN, DDT, MLD, SCAN
Electrophysiological tests: N1P2 speech in noise
Binaural Hearing
Binaural Hearing
Binaural HearingAuditory Brainstem Response
Binaural Hearing
Wave I/II Wave III
Wave V
Auditory Brainstem Response
Normal: (L+R) > BIN
Binaural Interaction ComponentThe difference between the sum of the two Monaural ABRs and the Binaural ABR
Fowler & Broadard 1988
LeftRight
Binaural (BIN)Left + Right
Binaural Interaction ComponentThe difference between the sum of the two Monaural ABRs and the Binaural ABR
Abnormal: (L+R) = BIN • Neural disorders
• CAPD
• animal model with intentional lesion
1. Fowler 20022. Delb 2003; Gopal & Pierel 19993. Wada & Starr 1989; Gardi & Berlin 1981
abnormalnormal
L + R
BIN
I II III IV V I II III IV V
Binaural Interaction Component
Disappears at ILD >16dB and ITD> 1.6msec
Behavioral tests show that Binaural Interaction disappears when signal is no longer intracranially fused
Furst 1985, McPherson & Starr 1995
The BIC correlates well with psychophysical measures of binaural processes
Binaural Interaction ComponentHow to measure
1. “Difference Waveform”
2. “BIC Amplitude”
3. “BIC Ratio”
Difference Waveform
Control
Abnormal
Binaural Interaction ComponentHow to measure
Fowler 1988
Binaural Interaction ComponentHow to measure
BIC Amplitude = Monaural Aggregate – Binaural response Values closer to zero indicate smaller Binaural Interaction.
Gopal et al 1998
Wave V amplitude (µV) Controls CAPDMonaural Aggregate (L+R) 1.32 0.98BIN 0.91 0.89BIC Amplitude= (L+R)-BIN 0.41 0.09
Binaural Interaction Component
BIC Ratio = Binaural response ÷ Monaural AggregateValues closer to one indicate smaller Binaural Interaction.
How to measure
Gopal et al 1998
Wave V amplitude (µV) Controls CAPDMonaural Aggregate (L+R) 1.32 0.98BIN 0.91 0.89BIC Amplitude= (L+R)-BIN 0.41 0.09BIC Ratio BIN/L+R 0.69 0.91
Research Question
Do Veterans with DM have a decreased BIC of the ABR when compared to Veterans without the disease?
Methods• ABR obtained and scored from 81 subjects
As part of a larger Longitundal study on Diabetes and Hearing Loss
• Subset of 47 subjects met inclusion criteria
Methods• ABR obtained from 81 subjects
As part of a larger Longitundal study on Diabetes and Hearing Loss
• Subset of 47 subjects based on inclusion criteria
• Wave V was initially selected with an automated algorithm based on criteria set for a predicted latency window (5.6 – 6.5 ms.)
• Double scored by experienced examiners
MethodsWave I Wave II Wave III Wave V
Control Subject DM Subject
ResultsDifference waveform
L+R
BIN
BIC
L+R
BIN
BIC
Results
Results
Left 0.63Right 0.62
x axis Monaural Aggregate (L+R) 1.25y axis Binaural 0.78
Wave V Peak-baseline amplitude (µv) for one control subject (marked as blue star)
Results
Values closer to zero indicate smaller Binaural Interaction.
BIC Amplitude
ControlWeihing 2008 controls
T2DMGopal & Pierel 1999 CAPD
(n=24) (n=15) (n=23) (n=9)
0.210 0.180 0.156 0.089 0.39
Table 2. Raw mean BIC Amplitude results (µV) by Diabetes status.
BIC Amplitude (L + R) - BIN
P-value
Results
Values closer to zero indicate smaller Binaural Interaction.
BIC Amplitude
Control T2DM(n=24) (n=23)
0.210 0.156
BIC Amplitude (L + R) - BIN
Table 2. Raw mean BIC Amplitude results (µV) by Diabetes status.
Results
Values closer to one indicate smaller Binaural Interaction.
BIC Ratio
ControlWeihing 2008 controls
T2DMGopal & Pierel 1999 CAPD
(n=24) (n=15) (n=23) (n=9)
0.725 0.876 0.788 0.909 0.57
Table 3. Raw mean BIC Ratio results by Diabetes status.
P-valueBIC Ratio BIN/L+R
Results
Values closer to one indicate smaller Binaural Interaction.
BIC Ratio
Control T2DM(n=24) (n=23)
0.725 0.788
BIC Ratio BIN/L+R
Table 3. Raw mean BIC Ratio results by Diabetes status.
Results
P value= .7439AIC: -45.6
Discussion• Different ways to measure Binaural Interaction
Contributions:
Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
Contributions:
Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
• Curved line is the best fit to describe Binaural Interaction
Contributions:
Discussion• Different ways to measure Binaural Interaction
• No statistically significant difference in Binaural Interaction between T2DM and Controls
• Curved line is the best fit to describe Binaural Interaction
• Benefits to regression model
Contributions:
DiscussionFuture direction:
• Longitudinal study • Compare to gold standard, ROC analysis• BIC of MLR & LLR• BIC-focused study that varies parameters
• BIC threshold• Use in impaired populations
• Blast subjects• Other BIC applications
Thank youDawn Konrad-MartinMarilyn DilleGarnett McMillanJane Gordon Dan McDermottNCRAR StaffSara Sell