Clinical Application of the P1 Cortical Auditory Evoked Potential Biomarker in Children with Sensorineural Hearing Loss and Auditory Neuropathy Spectrum Disorder

ABSTRACT

The P1 component of the cortical auditory evoked potential (CAEP) shows age-related decreases in latency and changes in morphology in normal-hearing children, providing a biomarker for development of the auditory cortical pathways in humans. In hearing-impaired children, auditory deprivation may affect the normal age-related changes in central auditory maturation. Appropriate early intervention with amplification and/or electrical stimulation can provide the necessary stimulation needed to drive progress in central auditory maturation and auditory skill development; however, objective measures are needed to evaluate the effectiveness of these treatments in infants and young children. We describe three pediatric cases in which we explored the clinical utility of the P1 as an objective biomarker of auditory cortical development after early intervention. We assessed development of P1 CAEP latency and morphology in two children with sensorineural hearing loss who received intervention with hearing aids (case 1) and cochlear implants (case 2) and a child with auditory neuropathy spectrum disorder (case 3). Overall, we find that the P1 CAEP serves as a useful tool for assessing the effectiveness of early intervention treatment and clinical management of pediatric hearing-impaired patients.

Cochlear implant - P1 - biomarker - hearing aid - children - cortical auditory evoked potential - auditory neuropathy spectrum disorder - hearing impairment - pediatric

REFERENCES

• 1 Sharma A, Dorman M, Spahr A, Todd N W. Early cochlear implantation in children allows normal development of central auditory pathways.  Ann Otol Rhinol Laryngol Suppl. 2002;  189 38-41
• 2 Sharma A, Dorman M F, Spahr A J. Rapid development of cortical auditory evoked potentials after early cochlear implantation.  Neuroreport. 2002;  13 (10) 1365-1368
• 3 Sharma A, Dorman M F, Spahr A J. 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) 532-539
• 4 Sharma A, Dorman M F, Kral A. The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants.  Hear Res. 2005a;  203 (1-2) 134-143
• 5 Ceponiene R, Rinne T, Näätänen R. Maturation of cortical sound processing as indexed by event-related potentials.  Clin Neurophysiol. 2002;  113 (6) 870-882
• 6 Gilley P M, Sharma A, Dorman M, Martin K. Developmental changes in refractoriness of the cortical auditory evoked potential.  Clin Neurophysiol. 2005;  116 (3) 648-657
• 7 Sharma A, Kraus N, McGee T J, Nicol T G. Developmental changes in P1 and N1 central auditory responses elicited by consonant-vowel syllables.  Electroencephalogr Clin Neurophysiol. 1997;  104 (6) 540-545
• 8 Ponton C W, Eggermont J J, Kwong B, Don M. Maturation of human central auditory system activity: evidence from multi-channel evoked potentials.  Clin Neurophysiol. 2000;  111 (2) 220-236
• 9 Kral A, Eggermont J J. What's to lose and what's to learn: development under auditory deprivation, cochlear implants and limits of cortical plasticity.  Brain Res Brain Res Rev. 2007;  56 (1) 259-269
• 10 Eggermont J J, Ponton C W. Auditory-evoked potential studies of cortical maturation in normal hearing and implanted children: correlations with changes in structure and speech perception.  Acta Otolaryngol. 2003;  123 (2) 249-252
• 11 Huttenlocher P R, Dabholkar A S. Regional differences in synaptogenesis in human cerebral cortex.  J Comp Neurol. 1997;  387 (2) 167-178
• 12 Sharma A, Dorman M F. Central auditory development in children with cochlear implants: clinical implications.  Adv Otorhinolaryngol. 2006;  64 66-88
• 13 Sharma A, Martin K, Roland P et al.. P1 latency as a biomarker for central auditory development in children with hearing impairment.  J Am Acad Audiol. 2005b;  16 (8) 564-573
• 14 Kraus N, Bradlow A R, Cheatham M A et al.. Consequences of neural asynchrony: a case of auditory neuropathy.  J Assoc Res Otolaryngol. 2000;  1 (1) 33-45
• 15 Rance G, Cone-Wesson B, Wunderlich J, Dowell R. Speech perception and cortical event related potentials in children with auditory neuropathy.  Ear Hear. 2002;  23 (3) 239-253
• 16 Sharma A, Cardon G, Henion K, Roland P. Cortical maturation and behavioral outcomes in children with auditory neuropathy spectrum disorder.  Int J Audiol. 2011;  50 (2) 98-106
• 17 Zimmerman-Phillips S, Robbins A M, Osberger M J. Assessing cochlear implant benefit in very young children.  Ann Otol Rhinol Laryngol Suppl. 2000;  185 42-43
• 18 Sharma A, Nash A A, Dorman M. Cortical development, plasticity and re-organization in children with cochlear implants.  J Commun Disord. 2009;  42 (4) 272-279
• 19 Sharma A, Dorman M, Biever A, Gilley P, Nash A, Campbell J. A sensitive period for cortical development and plasticity in children with sequential bilateral cochlear implants. Poster presented at: Annual Meeting of the Association for Research in Otolaryngology; February 6–10, 2010; Anaheim, CA
• 20 Gilley P M, Sharma A, Dorman M, Finley C C, Panch A S, Martin K. Minimization of cochlear implant stimulus artifact in cortical auditory evoked potentials.  Clin Neurophysiol. 2006;  117 (8) 1772-1782
• 21 Kirk K I, Pisoni D B, Osberger M J. Lexical effects on spoken word recognition by pediatric cochlear implant users.  Ear Hear. 1995;  16 (5) 470-481
• 22 Berlin C I, Bordelon J, St John P et al.. Reversing click polarity may uncover auditory neuropathy in infants.  Ear Hear. 1998;  19 (1) 37-47