Clinical Neurophysiology 124 (2013) 474–480

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Clinical Neurophysiology
journal homepage: www.elsevier.com/locate/clinph

Stimulus level effects on speech-evoked obligatory cortical auditory evoked

potentials in infants with normal hearing
S.C. Purdy a,b,c,⇑, M. Sharma b, K.J. Munro d, C.L.A. Morgan c
a
The University of Auckland, New Zealand
b
Macquarie University, Hearing CRC, Australia
c
National Acoustic Laboratories, Sydney, Australia
d
University of Manchester, United Kingdom

a r t i c l e i n f o h i g h l i g h t s

Article history:  This study shows robust cortical auditory evoked potential (CAEP) amplitudes at low stimulus levels in
Accepted 16 September 2012 infants.
Available online 30 October 2012  The effect of stimulus level on CAEP latencies differs between speech stimuli.
 CAEP input–output functions for infants differ from published findings for adults.
Keywords:
Cortical auditory evoked potential
Infant a b s t r a c t
Speech
Stimulus level Objective: To determine stimulus level effects on speech-evoked cortical auditory evoked potentials
Input–output function (CAEPs) in infants for a low (/m/) and high (/t/) frequency speech sound.
Loudness Methods: CAEPs were recorded for two natural speech tokens, /m/ and /t/. Participants were 16 infants
aged 3–8 months with no risk factors for hearing impairment, no parental concern regarding hearing
or development, and normal tympanograms and otoacoustic emissions. Infants were either tested at lev-
els of 30, 50, and 70 dB SPL or at 40, 60, and 80 dB SPL, in counterbalanced order.
Results: Input–output functions show different effects of increasing sound level between stimuli. There
were minimal changes in latency with increase in level for /t/. For /m/, there were approximately 50–
60 ms latency increases at soft compared to loud levels. Amplitudes saturated at moderate–high levels
(60–80 dB SPL) for both stimuli.
Conclusions: Infants’ CAEP input–output functions differ for /t/ versus /m/ and differ from those previ-
ously reported for adults for other stimuli. Effects of stimulus and level on CAEPs should be considered
when using CAEPs for hearing aid or cochlear implant evaluation in infants.
Significance: Speech-evoked CAEPs provide an objective measure of central auditory processing. Possible
differences in CAEP growth between infants and adults suggest developmental effects on intensity coding
by the auditory cortex.
Ó 2012 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical
Neurophysiology.

1. Introduction
Obligatory cortical auditory evoked potentials (CAEPs) can pro-
vide source and timing information regarding neural processes
that underlie speech perception (Alain and Tremblay, 2007; Oates
et al., 2002; Martin et al., 2008). In addition, CAEPs can be used
clinically to assess auditory system maturation, auditory process-
ing ability, and speech audibility in infants with hearing loss
(Rapin and Graziani, 1967; Gravel et al., 1989; Sharma et al.,
⇑ Corresponding author at: School of Psychology (Speech Science), University of
Auckland, Building 721, Tāmaki Innovation Campus, Private Bag 92019, Auckland,
New Zealand. Tel.: +64 9 3737599x82073; fax: +64 9 373 7902.
E-mail address: sc.purdy@auckland.ac.edu (S.C. Purdy).
2002; Golding et al., 2007; Martin et al., 2008). CAEPs are robust
responses that can been evoked by clicks, tones, and speech
sounds across the life span, in infants (Kurtzberg et al., 1984;
Ponton et al., 2002; Purdy et al., 2004), young children (Ponton
et al., 1996; Cunningham et al., 2000; Ceponiene et al., 2002;
Sharma et al., 2007), adolescents (Ponton et al., 1996; Cunningham
et al., 2000), young adults (Ponton et al., 1996; Cunningham et al.,
2000; Wunderlich and Cone-Wesson, 2001; Sharma et al., 2002),
and the elderly (Cunningham et al., 2000). Although CAEP peaks,
especially P2, are influenced by attention (Coch et al., 2005),
obligatory CAEPs are typically recorded using a passive listening
paradigm, with the listener watching a silent subtitled video
or reading. Infants can be tested while they are awake and
distracted by a visually engaging toy or book (Purdy et al.,

1388-2457/$36.00 Ó 2012 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology.
http://dx.doi.org/10.1016/j.clinph.2012.09.011
 S.C. Purdy et al. / Clinical Neurophysiology 124 (2013) 474–480
2004) or during ‘‘active’’ sleep (Kurtzberg et al., 1984; Novak
et al., 1989; Kushnerenko et al., 2001).
Stimulus parameters that influence CAEP characteristics include
presentation rate (Budd et al., 1998; Sharma et al., 2007), stimulus
duration (Onishi and Davis, 1968; Agung et al., 2006; Beukes et al.,
2009), stimulus level (Madell and Goldstein, 1972; Garinis and
Cone-Wesson, 2007), and type of speech sound (Kurtzberg, 1989;
Sharma and Dorman, 1999; Agung et al., 2006) or tonal stimulus
frequency (Jacobson et al., 1992). Golding et al. (2006) recorded
speech-evoked CAEPs in infants and reported significantly smaller
and later P1 latencies for /m/ compared to /t/, across a range of
stimulus durations and inter-stimulus intervals. This is consistent
with a magnetoencephalography study of adult listeners by Gage
et al. (1998), that showed larger cortical amplitudes and shorter
latencies for words with initial stop consonants (/b/, /p/, /d/, /t/,
/g/, /k/) versus non-stops (/f/, /l/, /m/, /r/, /s/). Gage et al. (1998)
suggested that these differences are due to stops having greater
energy at onset than other sounds. The auditory cortex is domi-
nated by neurons with discharge spikes time-locked to the onset
of auditory stimuli (Heil, 1997) and the /t/ stimulus has a much fas-
ter onset-to-peak time than /m/ (Golding et al., 2006). Prasher
(1980) investigated whether onset effects on CAEP latencies and
amplitudes are affected by spectral splatter effects by comparing
effects of rise time for tones and noise, and found that latencies re-
duced with stimulus rise time for noise and tonal stimuli, but
amplitude increases for short rise times only occurred for tonal
stimuli. Thus, both spectral and temporal differences are likely to
account for the latency and amplitude differences between /m/
and /t/ CAEPs reported by Golding et al. (2006).
The effects of stimulus parameters on infant CAEPs have not
been investigated as extensively as they have in adults (Hyde,
1997). A number of studies have shown that, for stimulus rates
of about 1 per second, CAEPs in infants are dominated by the P1
peak occurring at about 100–300 ms after stimulus onset, followed
by a late negativity at about 350 ms (Kurtzberg et al., 1984; Ponton
et al., 1996; Kushnerenko et al., 2001; Sharma et al., 2002; King
et al., 2008).
The adult CAEP waveform consists of distinct P1, N1, and P2
peaks. Up to about 7 years of age the vertex-recorded cortical po-
tential often primarily consists of a single positive wave rather
than a P1–N1–P2 complex. P1 latency shows considerable matura-
tional change in the preschool period, reducing from several hun-
dred milliseconds in very young infants (e.g. Sharma and
Dorman, 2006) to approximately 100 ms at 5 years (see review
by Wunderlich and Cone-Wesson, 2006). CAEPs recorded in adults
using similar stimulus presentation rates have earlier P1, N1, and
P2 peaks occurring at about 50, 100, and 200 ms, respectively.
The time range of the adult N1–P2 overlaps with the infant P1
occuring between 100 and 300 ms. Ponton et al. identified tangen-
tial and radial N1 sources, with differing maturational time
courses, and proposed that P1 is reduced in adults due to phase
cancellation of the later parts of the P1 peak by the increasing mag-
nitude of N1. Hence, when adult and infant studies are compared it
is difficult to separate stimulus influences on P1 and N1 since these
peaks in the CAEP waveform are likely to have overlapping sources.
Studies reporting effects of stimulus and recording parameters
on CAEPs in adults generally focus on N1. Adult findings cannot
be readily extrapolated to infants, however, since P1, N1, and P2
have different sources and maturation patterns (Ponton et al.,
2002) and thus the effects of stimulus parameters may differ across
these peaks. In adults P1 is small; reduced P1 amplitudes are asso-
ciated with the emergence of a large N1 in late childhood (Ponton
et al., 2002). Thus, intensity effects on P1 in adults may be difficult
to observe and have not been widely reported. In general, adult N1
and P2 latencies reduce and amplitudes increase as stimulus
level increases from near-threshold to loud levels, but there are
475
variations across studies in the shape of the input–output function
for CAEP latencies and amplitudes (Beagley and Knight, 1967; Pic-
ton et al., 1974; Morita et al., 2006; Kaskey et al., 1980; Garinis and
Cone-Wesson, 2007; Lütkenhöner and Klein, 2007). Differences in
stimulus type, duration and inter-stimulus interval, and the range
of presentation levels investigated are likely to account for the var-
iation in findings.
To our knowledge CAEP input–output characteristics have not
been reported for infants. CAEP input–output characteristics are
of interest because of the use of CAEPs to evaluate the audibility
of amplified speech in children with hearing impairment (Purdy
et al., 2004; Martin et al., 2008). The aim of the current study
was to assess the effects of stimulus level on latencies and ampli-
tudes of speech-evoked CAEPs in infants, using two speech sounds
(/m/ and /t/) with different spectral and temporal characteristics
that are known to produce differences in CAEP morphology.
2. Materials and methods
2.1. Participants
Participants were 16 infants (5 girls and 11 boys) aged 2.5–
10 months (mean 5.3 months, SD 2.6), with no risk factors for
hearing impairment and no parental concerns about hearing.
Prior approval for the study was obtained from Ethics Review
Board of University of Auckland. All participants had normal
1000-Hz tympanograms (Baldwin, 2006) on the day of testing
and passed transient evoked otoacoustic emission testing. Infants
were randomly divided into two groups to be tested using levels
of either 30, 50 or 70 dB SPL, or 40, 60 and 80 dB SPL for the two
stimuli. This approach was taken since a pilot study suggested it
may not be possible to maintain infant cooperation for long en-
ough to test two stimuli and six presentation levels, and partici-
pant recruitment was facilitated by having one test session per
infant. Table 1 provides a summary of these two groups. Testing
was terminated when babies could not be distracted anymore.
Test sessions lasted 45 min to 2 hours, with testing interrupted
with feeding when necessary. Some infants could not be tested
at the three pre-determined levels for the two stimuli, or some
trials did not have enough averages due to excessive stimulus
artifact and thus the data could not be included in the statistics.
Eleven infants (69%) completed all or 5 out of 6 assigned condi-
tions (3 levels, 2 stimuli). For each stimulus and each presenta-
tion level, data was obtained from between five and eight
participants.
2.2. Stimuli
CAEPs were collected in response to two 78 ms natural speech
tokens /t/ and /m/. These two sound tokens were chosen with dom-
inant energy in the high and low frequencies, respectively (see
Fig. 1). The speech tokens were extracted from running speech spo-
ken by an Australian male (Golding et al., 2006). The stimuli were
initial consonants extracted from the speech sample and truncated
to remove the subsequent vowel (/ae/). After this processing the /t/
stimulus is perceived as human speech and /m/ has a ‘buzz-like’
sound quality. The two stimuli differ spectrally and temporally;
/t/ is a high-frequency, aperiodic unvoiced plosive, while /m/ is a
lower-frequency, periodic voiced nasal sound. The stimuli were
presented at an interstimulus interval of 1125 ms at levels of 30–
80 dB SPL, counterbalanced in 10 dB steps. Speech sounds were
presented via a Turbosound IMPACT 50 loudspeaker placed at 0°
azimuth (right in front of the infant) at a distance of 1.5 m and a
height of 1.4 m, with the face of the loudspeaker angled down-
wards at 45° to reduce variability in the sound at the infant’s ear-
canal (Killion and Revit, 1987). This arrangement allowed the
476 S.C. Purdy et al. / Clinical Neurophysiology 124 (2013) 474–480
Table 1
Summary of the test conditions across participants for the sounds /t/ and /m/. Babies were randomised into group O (odd) or E (even) and were allocated odd or even stimulus
levels depending on which group they were assigned to.
Sounds Group Levels (dB SPL)
/t/ O 30
50
70
E 40
60
80
/m/ O 30
50
70
E 40
60
80
Fig. 1. Time waveforms and frequency spectra of the /m/ and /t/ stimuli.
person distracting the infant to be located below and to the side of
the loudspeaker. A flat soundfield frequency response was
achieved by routing the CAEP stimulus through an Australian Mon-
itor Synergy SY400 power amplifier and Sabine Graphi-Q GRQ-
3102 equalizer that had been adjusted to achieve levels within
±2.5 dB from 80 to 10 kHz using a white noise stimulus. Speech
stimuli were calibrated in dB SPL (rms) using a half-inch polarized
condenser free-field microphone connected to a Bruel and Kjaer
measuring amplifier (linear weighting, impulse response) and
oscilloscope.
2.3. Evoked response recording
Participants sat on the caregiver’s lap facing a researcher sitting
in a small chair below the loudspeaker who distracted the infant
using silent toys and books. Electrodes were attached at C3, Cz,
and C4, referenced to the right mastoid with the forehead as
ground. Only CAEPs measured from the vertex midline (Cz) elec-
trode were analyzed, as this location provided the most stable elec-
trode attachment and impedance values across the recording
session. The online artifact rejection rate was set at ±100 lV. Ac-
cepted runs had <50% artifact rejection rates. Speech stimuli were
presented via Neuroscan STIM 2 and CAEPs were acquired using
Neuroscan SCAN Acquisition software version 4.3.1 and SynAmps2
amplifiers. Online evoked response recording was performing
using a digital bandpass FIR filter of 1–100 Hz and a gain setting
of 1000.
No. of participants Ratio of males:females Mean age in months ± 1 SD
6 6:0 5.2 (3.0)
8 7:1 5.6 (2.6)
7 6:1 6.0 (2.4)
6 4:2 5.3 (2.8)
6 4:2 5.4 (2.8)
6 4:2 5.4 (2.8)
5 5:0 6.6 (2.7)
7 6:1 5.6 (2.8)
6 5:1 6.2 (2.6)
5 2:3 5.3 (3.3)
7 2:4 5.6 (3.0)
6 2:4 5.6 (3.0)
2.4. Data analysis
Offline analysis involved converting continuous EEG data to
epoch files with a time window of 100 to 600 ms (with baseline
correction in the pre-stimulus interval). CAEPs were then bandpass
filtered (1–30 Hz low pass filtered, 24 dB/octave) using FIR zero
phase shift digital filtering. There were approximately 200 aver-
ages for each condition at each level for each participant. P1 laten-
cies and amplitudes were measured for all individual average
waveforms for each stimulus and presentation level. Waveform
peaks were visually identified by three of the researchers. Initial
peak picking was performed by two researchers; a third researcher
blinded to the stimulus intensity subsequently reviewed the wave-
forms and peaks were identified based on a consensus amongst the
three researchers. P1 was identified as the most robust positivity in
the range of 100–300 ms. If CAEPs were present across C3, C4 and
Cz electrode positions, then peak amplitudes, latencies and mor-
phology were expected to be approximately consistent across elec-
trode positions. This was used as a guide only when peak picking
the response recorded at Cz, as some variations in amplitudes
and latencies might occur between central and right/left hemi-
sphere electrodes (Paavilainen et al., 1991; Alain and Tremblay,
2007). Peak picking was performed at Cz only as electrode contact
was very stable in this midline location but was more variable at
C3 and C4. Two-factor repeated-measures (signal [2], level [6])
analyses of variance were performed using Statistica 7.0 to deter-
mine stimulus and level effects on P1 latencies and amplitudes.
 S.C. Purdy et al. / Clinical Neurophysiology 124 (2013) 474–480
Planned comparisons were used to investigate differences between
individual stimulus levels.
3. Results
Grand average CAEP waveforms recorded in response to /m/
and /t/ are shown in Fig. 2. All infants had a P1 response at approx-
imately 150–200 ms, followed by a negativity at about 250–
300 ms. There is an additional earlier biphasic response (positivity
followed by a negativity) evident in the /t/ grand average wave-
forms for the higher stimulus levels. This biphasic peak evident
in the responses to /t/ at higher stimulus levels is the post auricular
response (PAMR), occurring at approximately 20–50 ms (Agung
et al., 2005; Golding et al., 2006). PAMR is a brainstem response
that is influenced by the stimulus type, level and eye movement.
PAMR is optimally recorded using bilateral, high level, high fre-
quency stimuli (Agung et al., 2005).
Overall /m/ produced longer CAEP latencies and smaller ampli-
tudes than /t/ (Fig. 3). Because the cohort of children tested with
each stimulus was not identical and the group sizes are small, a
conservative nonparametric analysis was performed to see
whether /m/ and /t/ latencies and amplitudes differed significantly.
A Kruskal–Wallis ANOVA showed that latencies differed between
speech stimuli at 30 dB (p = 0.018), 40 dB (p = 0.006), 50 dB
(p = 0.002), 60 dB (p = 0.007) and 80 dB (p = 0.021), but not at
70 dB (p = 0.087). P1 amplitudes differed significantly between
speech stimuli only at 40 dB (p = 0.029) and 60 dB (p = 0.025). To
improve statistical power for these comparisons, low (30–40 dB),
medium (50–60 dB), and high (70–80 dB) intensity data were
pooled and latencies and amplitudes were compared at each level
Fig. 2. Grand average CAEP waveforms (n = 6–8 infants per waveform), showing P1
at approximately 150–200 ms across stimulus levels of 30–80 dB SPL, for /t/ (left
panel) and /m/ (right panel) speech sounds. The early biphasic response evident at
higher intensity levels in the /t/ waveforms is post auricular muscle response
(PAMR).
477
between stimuli. As was seen for the comparison of individual
intensities, there were significant latency differences between
stimuli at low (p = 0.004) and medium (p = .005) levels, but not
at the highest intensities (p = 0.062). P1 amplitudes for the pooled
level data did not differ between stimuli for low (p = 0.335), med-
ium (p = 0.821), or high (p = .221) intensities.
P1 amplitude varied significantly across levels for /m/ when
stimulus levels were analyzed separately [F(5, 20) = 5.22,
p = 0.003] and for pooled intensity data [F(2, 10) = 9.34, p = 0.005].
Results of planned comparisons used to compare amplitudes be-
tween stimulus levels are summarized in Table 2. P1 amplitudes
at 30 dB SPL were significant smaller than those at 50, 60, 70,
and 80 dB SPL. P1 was also significantly smaller at 40 dB SPL than
at 50 and 60 dB SPL. This pattern of /m/ amplitude growth for low–
medium stimulus levels (30–60 dB) and saturation at high levels
(70–80 dB) was confirmed by the analysis of the pooled data,
which showed a significant amplitude difference between low
and medium (p = .006) but not between medium and high
(p = 0.536) intensities. Although Fig. 3 shows small, but generally
consistent increases in P1 amplitudes with stimulus level for /t/,
the differences across stimulus level were not statistically signifi-
cant when the analysis was performed for separate [F(5, 10) =
1.85, p = 0.190] intensities, but there was significant amplitude
growth when intensity levels were pooled [F(2, 16) = 3.91,
p = 0.042). Amplitudes differed for low versus medium
(p = 0.011), but not medium versus high (p = 0.410) intensities.
Thus, both stimuli showed a pattern of increasing amplitude with
increase in level from low to medium intensities, with saturation at
higher levels.
P1 latencies did not vary significantly with stimulus level for /t/
for either separate [F(5, 10) = 1.27, p = 0.349] or pooled [F(2, 16) =
0.33, p = 0.722] analyses. While /t/ latencies were unaffected by
stimulus level, /m/ latencies became increasingly shorter as the
stimulus became louder. The change in P1 latency with stimulus
level for /m/ was statistically significant for the pooled level anal-
ysis [F(2, 18) = 4.89, p = 0.020]. Planned comparisons showed long-
er /m/ P1 latencies at 40 dB than at 70 (p = 0.037) or 80 (p = 0.019)
dB SPL. Latencies of /m/ responses did not differ when low versus
medium levels were compared (p = 0.465), but were significantly
shorter at high versus medium (p = 0.042) intensities. Thus the
greatest change in /m/ latencies was at high intensities, at the point
where the amplitude of the /m/ cortical response is saturating in
these infants.
4. Discussion
The current study was undertaken to determine the effects of
stimulus level on cortical responses to a high and a low frequency
speech sound in babies. CAEPs were recorded across the range of
stimulus levels for both stimuli. CAEPs show a trend of increasing
amplitudes up to 50 dB SPL for /m/ and up to 60 dB SPL for /t/. The
differences in amplitude across stimulus level were not significant
for /t/. This may be due to a lack of statistical power as a result of
the small sample size and amplitude variability across infants.
Alternatively, differences in amplitude growth could reflect differ-
ences in the nature of the stimuli. This is difficult to answer di-
rectly given the variability in response amplitudes and lack of
other test stimuli for comparison. The /t/ stimulus has a relatively
fast stimulus onset and noise-like spectrum, somewhat like a click.
Earlier studies using click stimuli have shown CAEP amplitude
growth with comparable changes in stimulus level. For adult lis-
teners, Picton et al. (1974) showed increasing N1 and P2 click
evoked CAEP amplitudes across a wider range of stimulus intensi-
ties from 30 to 80 dB sensation level (SL). Similarly, Beagley and
Knight (1967) reported little change in amplitude and latency at
60–70 dB SL, but below these levels reductions in stimulus level
478 S.C. Purdy et al. / Clinical Neurophysiology 124 (2013) 474–480
Fig. 3. Mean P1 amplitudes (top panel) and latencies (bottom panel) for /t/ and /m/ stimuli, across levels from 30 to 80 dB SPL. Error bars indicate ±1 standard error.
Table 2
Summary of the outcomes of the statistical planned comparisons (ns = not significant)
comparing P1 amplitudes between stimulus levels for /m/. None of the contrasts were
significant for /t/.
produced significant changes in amplitude and latency. Other stud-
ies using tonal or speech stimuli have found that adult CAEP ampli-
tudes saturate at lower intensities, as was seen for the infants in
the current study. Lütkenhöner and Klein (2007) found that, for
neuromagnetic recordings of N1 and P2, latencies reduced and
amplitudes increased rapidly with increase in tonal stimulus level
from 2 to 20 dB SL, with much smaller changes with level between
20 and 40 dB SL. Garinis and Cone-Wesson (2007) saw a similar
pattern of saturating amplitude growth for consonant–vowel
speech stimuli at levels of 0 to 40 dB SL, but found linear decreases
in latencies with level. Garinis and Cone-Wesson (2007) used a
slower stimulus presentation rate than Lütkenhöner and Klein
(2007), which may account for the difference in latency results.
Morita et al.’s (2006) data is consistent with these studies, showing
reducing N1m latencies for tones in quiet from 40 to 50 dB SPL and
no change in latency with further increases in stimulus intensity.
For soft presentation levels CAEP amplitudes increased more for
/m/ than for /t/. The /m/ stimulus resulted in less variation in laten-
cies across levels, and substantial decrease in amplitudes at near
threshold levels. The /t/ stimulus produced CAEPs with similar
latencies across level and only a small reduction in average ampli-
tudes at soft levels. With the increased sample size for the pooled
data, the reduction in amplitude for /t/ when intensity reduced
from mid to low intensities was significant. The patterns of ampli-
tude and latency change across level for the two stimuli were quite
distinct, however. Previous studies have not investigated stimulus
effects on human CAEP input–output functions however, Hart et al.
(2003) found differences in the growth of fMRI activation for
300 Hz versus 4750 Hz tones for sound levels between 42 and
96 dB SPL. For the low frequency tone, the extent of activation
was flat up to 66 dB and then showed a rapid growth which contin-
ued up to 96 dB SPL. In contrast, increasing the level of the higher
frequency tones produced a steady growth in the extent of activa-
tion across the range of levels studied. Hart et al. (2003) concluded
that recruitment of primary auditory cortical neurons may be dif-
ferent at high and low frequencies. The changes in evoked poten-
tial amplitudes seen for infants in the current study were very
different from this pattern. The findings do support Hart et al.’s
(2003) conclusion regarding differences in high versus low fre-
quency cortical processing. In addition to possible differences in
cortical input–output functions between low and high frequency
stimuli, the /m/ and /t/ stimuli should produce different patterns
of cochlear excitation with increasing stimulus level. The /m/ stim-
ulus is a relatively narrowband, low frequency stimulus; increasing
stimulus intensity would presumably result in upward spread of
cochlear excitation. The /t/ stimulus has peak energy at approxi-
mately 3000 Hz, however, the acoustic spectrum is relatively broad
and hence less change in cochlear excitation would be expected
with increasing stimulus level.
Abdala and Folsom (1995) found that, compared to adults,
3 month olds had broader 8000 Hz neural tuning curves derived
using notched noise masking of the auditory brainstem response.
By 6 months of age, low and high frequency tuning was adult-
like. In the current study input–output functions for the low fre-
quency speech sound /m/ were more adult-like than those ob-
served for /t/. For /m/, latencies reduced at high intensities and
there was considerable amplitude growth at low presentation
levels. For the high frequency speech sound /t/, although the
pooled analysis showed significant growth in amplitude for /t/
from low to mid intensity levels, latencies did not change signif-
icantly and the changes in amplitude across intensity were less
than those seen for /m/. This is consistent with Abdala and Fol-
som’s (1995) observation of less mature high frequency neural
processing in young infants at the level of the auditory
brainstem.
 S.C. Purdy et al. / Clinical Neurophysiology 124 (2013) 474–480
Stimulus type influenced P1 morphology, amplitude, and la-
tency. The /m/ stimulus resulted in longer P1 latencies and smaller
P1 amplitudes than /t/. The results of the current study have impli-
cations for aided CAEP testing for clinical evaluation of hearing aids
and cochlear implants; improved stimulus audibility should im-
prove CAEP amplitudes and reduce latencies, but only over a rela-
tively small range of stimulus levels. Substantial P1 latency
reductions reported in the literature for children receiving cochlear
implants (e.g. Dorman et al., 2007) exceed the range of latency
changes seen in children with normal hearing when stimulus audi-
bility improves. This suggests that the changes in P1 seen after
early cochlear implantation reflect more than just improved
audibility.
5. Conclusions
CAEP input–output functions for /m/ and /t/ behave differently.
Increasing audibility influences speech-evoked CAEP amplitudes
and latencies, but only over a limited range of stimulus levels. If
the results obtained here are applicable to children with hearing
loss, CAEP amplitudes may be robust, even when stimuli are at
low sensation levels, particularly for the high frequency speech
sound /t/. Thus, loudness is unlikely to correlate with CAEP ampli-
tudes. The presence of CAEPs indicates stimulus audibility, but the
current findings for children with normal hearing indicate that
CAEPs may not be useful for determining where speech falls within
the child’s dynamic range. The American Academy of Audiology
(2003) Pediatric Amplification protocol recommends that stimuli
used for verification of hearing aid performance should represent
the frequency, intensity and temporal aspects of speech and that
speech perception should be evaluated where possible. Aided CAEP
testing offers the ability to assess speech perception objectively at
a young age (Dillon, 2005). The current results indicate that reli-
able CAEP responses with characteristic latencies and amplitudes
can be recorded to different natural speech stimuli at a range of
intensities in young infants. The CAEP technique and the stimuli
described here fit well with hearing fitting goals for children of
ensuring that hearing aids are not under-amplifying speech and
that they provide beneficial levels of sound across the speech spec-
trum (Scollie, 2006).
Acknowledgment
This research was supported in part by a Churchill Fellowship
awarded to the fourth author.
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