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