ABR

(AUDITORY
BRAINSTEM
RESPONSE)
PRESENTED BY : HEMANI
TOPIC COVERED
• Introduction
• The normal ABR waveform
• Neural generator of the ABR
• Uses of ABR
• Characterstics of normal ABR
• Factors affecting ABR
• Protocol for ABR
INTRODUCTION
• First described by Jewett and Williston in 1971.
• Recording of the synchronous electrical activity
recorded by a far-field electrode placed on the scalp in
response to a sound presented to the cochlea.
• Changes produced by the passage of electrical stimulus
generated in the cochlea through the neural pathway.
• ABR is a neurologic test of auditory brainstem
function in response to auditory(click) stimuli.
• The auditory brainsteam response is a complex
response to particular types of external stimuli
that represent neural activity generated at several
anatomical sites.
• It is a electrophysiological response from brain
stem in response to auditory stimulation, it is
helpful in assessment of functioning of auditory
pathway.
THE NORMAL ABR
WAVEFORM
• The normal ABR waveform is characterised by
five to seven vertex positive peaks that occur in
the time period from 1.4 to 8.0 ms after the onset
of the stimulus . The waves or peaks of the ABR
represent sum of neural activity from one or
more sources at various discrete points in time.
ABR WAVEFORM
USES OF ABR
• Detection of deafness in difficult to test patients.
• Used in screening newborn for deafness.
• Identification of the site of lesion in RETROCOCHLEAR
pathologies.
• Study of maturity of nervous system in newborns.
• Check the functional state of auditory neural pathways
 CHARACTERSTICS OF A
NORMAL ABR
• Absolute latency
• Interwave latency interval
• Interaural latency difference
• Latency intensity function
• Rate changes
• Amplitude
• Waveform morphology and replicability
Wave/ Peak Latency (ms) Inter peak
latency
I 1.6 ms I and III

II 2.5 ms 2.14 msec

III 3.7 ms III and V

IV 4.5 ms 1.94msec

V 5.6 ms I and V
4.08msec
LIMITATION OF ABR
• Time taken is high
• Require high voltage, low noise
• Not direct test of hearing sensitivity
• Not give information about auditory comprehension
• Intensity till 99dBnHL
• We can’t find out PTA
 PROCEDURE
• Sedation (In case of child/adult)
• Subject lying supine with pillow under his head.
• Room should be quiet
• Clean the scalp properly
• Electrode Placement:
• Disposable electrodes are placed:
• Red, Side A: Right Mastoids- Red,
• Side B: Left Mastoid
• Black:Forehead below
• blue- Blue:Forehead above black
• Impedance Testing:- Before performing ABR testing,
electrode impedances were checked
• It should be less than or equal to 5kohm
• Insert electrode impedence should be less than
2kohm
• Checking for Electrical Noise:
• Before beginning the test, it was checked to make
sure the EEG activity, in the EEG and Amplifier
window, was normal for a relaxed state and that the
signal did not contain artifacts waveforms reflecting
electrical noise
GENEARAL PRINCIPAL OF ABR
MEASUREMENTS
• Averaging principle – More is the noise , more is the
averaging, larger is the AER lesser is require for
averaging
• Stimulus principal — It is directly depend on the rate of
the stimulus
• Filter principal — We have to keep response and we cut
down the noise (unwanted activity).
INSTRUMENTATION
• Stimulus generator
• Transducer
• Electrode
• Preamplifier
• Common mode rejection
• Filters
• Artifact rejection
• Stimulus generator
• The stimulus of the choice is the clicks, with a duration of 100
micro seconds
• Stimulus should be able to presented independently to right and
left ears and most system allow binaural presentation.
• The polarity of the stimulus can be selected as either condensation
or rarefraction .
• Transducer

• Insert earphones ER-3 phone are

recommended.
• These earphones prevent the earcanal collapse
, increase interaural attenuation , comfortable
for long period of time, can attenuate more
surrounding noise than other earphones.
• Electrode
• The Abr recorded by attaching electrodes to the surface
of the scap. Montage of either three or four electrodes
are generally used for recording
• Two channel recording – Using a four electrode montage,
are recommended for neurological applications in order
to obtain ipsilateral and contralateral response.
• One channel recording – In this three electrode are used.
• Preamplifier
• The preamplifier are either near the attachment
point of the electrode or connected to the
electrodes through an electrode input box and
cable.
• When the preamplifier are near the point of
electrode attachment,some advantage in signal to
noise ratio may be obtained because the low –
amplitude signals will need to travel less distance.
• Common mode rejection
• The unrelated and outside electrical activity is
common to both electrode. When the voltage
at each of the electrode are subtracted from
each other electrical activity common to both
electrode is canceled called common mode
rejection and the remaining voltage is that
which actually differ between the two
electrodes.
• Filter
• It is an another way to remove some of the unwanted
electrical activity.
• Testing with Click stimuli A band pass filter is set in evoked
potential testing to remove as much of the background
noise and unwanted electrical activity with affecting the
frequency range.
• Filter setting of either 100 or 150 Hz on low frequency end
( high pass setting)
• 3000Hz on high frequency end ( low pass setting)
•Artifact rejection
• When a sweep occurs that contains excessive
voltage amplitudes, excessive noise it include in
the average, which can decrease the quality of a
recording.
• Most evoked potential system provide a method
where sweeps containing excessive noise can be
excluded from the ongoing average.
FACTORS AFFECTING ABR
• Stimulus factor (stimulus)
• Recording variable (variable) Acquisition
• Organismic
• Miscellaneous (calibration and
enviroment noise)
EFFECT OF STIMULUS
FACTORS
•Stimulus type
• Stimulus intensity
• Stimulus rate
• Stimulus polarity ( Rarefaction,
Condensation,Alternating)
• Stimulus duration
• Stimulus frequency
• Monaural versus Binaural Recording
•Stimulus type
• Click (transient stimulus)
• Pure tone do not use
• Continuous tone also not used
• Type – click, chirp click
STIMULUS INTENSITY
• ABR latency decreases and amplitude increases with
greater intensity from 70 or 80 dB nHL to the threshold
level.
• Wave V is most visible at lower intensity levels, where as
the earlier components tend to become undistinguished at
intensities of 25 to 35 dBnHL. Near the threshold of
response, wave I occur at 4 msec and wave V occur at
about 8.0 msec in adults.
• Stimulus rate
• The rate at which test stimuli are presented
affects both the latency and the amplitude of
the components of ABR .
• It is dependent on time window as well as
duration of stimulus. When there is more than
one stimulus in the same time window , the
recording will contain overlapping response and
distort waveform.
• Time window
• It is defined by the amount of time both before and after the
presentation of stimulus that will be analyzed in the recording.

• Stimulus repetition
• Number of sweeps needed for an average AEP is inversely
proportional to the SNR and amplitude.
• As the SNR improves and the amplitude of AEP increases,
the number of sweeps require for testing decreases.
•Stimulus polarity
• Stimulus polarities for ABR testing can be
selected as rarefraction, condensation, or
alternating between the condensation and
rarefraction stimuli.
• Although latencies do not change much with
different polarities, the waveform may change
in same individual and produce different
morphology in different individual.
EFFECTS OF RECORDING
FACTORS
• Electrode montage
• Filter setting
• Time window
• One versus two channels recording
• Number of sweeps
• Mode
• Averaging window
• Artifact rejection
• Masking
EFFECTS OF PATIENT FACTORS
• Age
• Gender
• Medication
• attention
• Hearing loss
• Body temperature
• Sleep
• Drugs
• Alcohol. Etc
 ELECTRODE PLACEMENT
• RECORDING ELECTRODE: Cz placed at vertex
• REFERENCE ELECTRODE: A1 placed at ipsi lateralear lobule
or mastoid process
• GROUND ELECTRODE: A2 placed at contralateral ear lobule
PROTOCOL FOR ABR ELECTED WITH AIR
CONDUCTION CLICK STIMULUS.
Stimulus Parameter Solution
Transducer Insert earphones

Type Click or chirp click

Mode Monoaural

Duration 0.1ms

Polarity Rarefraction or variable

Rate 21.1/sec

Intensity Variable in dBnHL

Repetition Variable

Masking (non test ear) Variable

Acquisition Parameter Solution

Electrodes

Non – inverting Fz

Inverting Ai

Ground common Fpz

Filter

High pass 30 or 75Hz

Low pass 3000Hz

Notch Nine

Amplification *100,000

Analysis time 15ms

Pre – stimulus time - 1ms

Display gain 0.25 to 0.30uv

PROTOCOL ABR ELECTED WITH BONE
CONDUCTION CLICK STIMULUS
Stimulus parameter Solution

Transducer B71 or B81

Type Click or chirp

Site Mastoid bone

Duration 0.1ms

Polarity Alternating

Rate 21.1/sec or 11.1/sec

Intensity Variable

Repetition Variable

Masking (non test ear) Variable

Acquisition Parameter Solution
Electrode
Non inverting Fz
Inverting Ai
Ground Fpz
Filter
High pass 30 or 75 Hz
Low pass 3000Hz
Notch None
Amplification *100,000
Analysis time 15ms
Pre stimulus time -1ms
Display gain 0.25 to 0.30 uv
Sweeps (stimulus) Variable
PROTOCOL FOR MEASUREMENT OF
FREQUENCY SPECIFIC (ABR ) WITH TONE
BURST STIMULATION
Stimulus parameter Solution

Transducer Insert

Type Conventional, chirp

Polarity Rarefraction or alternating

Rate 37.7/ sec

Duration Variable

Electrode site Fz - Ai

Filter setting 30 to 300 Hz

Acquisition Parameter Solution

Electrode site Fz - Ai

Fliter setting 30

Analysis time 15 to 20 ms

Display time 15 to 20 ms

Display gain 0.25 to 0.50uv

Sweeps Variable
SUMMARY
• In this presentation we cover the normal ABR
waveform , neural generator of ABR, use and
characteristic of ABR, testing procedure and different
protocol for ABR testing.By this function of middle ear
and cochlea and the central auditory pathways
through the brain stem.It is a neurological test of
auditory brain stem function in response to (click)
stimuli.
THANK
YOU !!!