R. BONIVER VERVIERS, BELGIUM

Key words.

Slow vertex response; conventional audiometry; forensic audiometry.

Abstract.

Cortical electric response audiometry (slow vertex responses) in forensic audiology. Theinterest of slow vertex response audiometry (cortical evoked response audiometry), mainly in thediagnosis of pseudohypacousis is reported.The procedure is of interest to forensic audiometry.In some cases, during forensic examination, the definition of the audiometric threshold is difficult because the patient tries to exaggerate his deafness.Although there are many tests to demonstrate the existence of non-organic hearing loss (NOHL)none of them allows us to obtain the auditory threshold exactly. Among them:

clinical observation of the patient,

several results of the audiometric threshold,

vocal audiometry,

Stenger's test,

Bekesy's test,

stapedius reflex threshold studies,

DAF test

ABEP (Auditory Brainstem Evoked Potentials (BISHARA et al.)), etc…In 1982, we published a preliminary study on the interest in the study of cortical evoked responsesaudiometry (CERA) in the field of expertise.

HYDE et al.

(6) published results confirming the interest in the study of slow vertex response innon-organic hearing loss.In this paper, the conclusions of twenty years experience are presented.

SLOW AUDITORY EVOKED POTENTIALS:THE END OF MALINGERING IN AUDIOLOGY.

1.Introduction

During these thirteen years, 1200 tests were performed on a number of subjects suspected of non-organic hearing loss and several cochlear pathologies.Most of the claimants were coal miners, asking a revalidation for their professional hypoacousy.

1.1. Test environment

Subjects were tested in a comfortable relaxed position, in a sound-proof room separated andisolated from the physician and apparatus.

1.2. Stimulus

Apparatus: Madsen 22-50

Tone Burst : - rise decay time 5 msec.,- duration time 40 msec.

Frequencies : 1 kHz, 2 kHz, 3 kHz

One stimulus every two seconds

n = 30

earphonesMasking the non-tested ear was required at high intensities (narrow band masking). The stimuluscalibration was controlled the first time by an artificial ear Bruel Kjaer 4152 (3-4) and subsequentlyin comparison to normal ears. The time of analysis was 500 msec. The band width was 0.25-15 Hz.

1.3.Testing procedure

Sitting in a comfortable position and given something to read or a videofilm to watch, the patientswere told not to move.

1.4. Analysis of the curve (fig. 1)

In our experience, the waves N1 and P2 were the most reproductible until the threshold, mainly N1.

2.Material and method3.Results

-2-

The measurements always began at 90 or 100 dBs. HL to obtain a good curve; then, the level wasreduced trial by trial in 20 dB steps until the threshold was crossed by a clearly negative trial, i.e.the absence of a visible slow potential, and controlled around this level in five dBs steps.The main problem was the exact interpretation of the threshold intensity level. To find thisthreshold with the best precision, it is absolutely necessary to have a good control of the vigilancestatus because when the patient is asleep or inattentive, the variability of the threshold is more than15 dB per frequency.The best control of the vigilance was obtained through reading or video stimulation.The threshold was reached when N1 was not reproduced by two stimulations at the same level.

1.5. Normal subjects

When the alertness of the subject was weak, and attention not sustained, the variability of thethreshold was greater.In ten people, an experiment was conducted in darkness, without any stimulation and at 1000 Hz:the threshold of conventional audiometry and CERA varied between 10-20 dB which is higher thanin comparison to the threshold in a normal situation.-3-