A timesaving BERA technique for frequency-specific assessment of the auditory threshold through tone-pulse series stimulation (TOPSTIM) with simultaneous gliding high-pass noise masking (GHINOMA).

A new stimulation paradigm is described for eliciting frequency-specific auditory brainstem responses (ABR) by stimulation with a series of seven Gaussian-shaped tone pulses with carrier frequencies descending, in half-octave steps, from 4,000 to 500 Hz, and an interstimulus interval between consecutive pulses of 18 ms. The pause between two consecutive series is 54 ms so that the interval between two tone pulses of the same frequency is 162 ms (stimulus repetition rate approximately 6/s). Simultaneously a high-pass noise masker is presented whose lower cut-off frequency is continuously diminished in such a way that, when a tone pulse is presented, the cut-off frequency of the masker is exactly one octave above the carrier frequency of the pulse. Forward masking effects of preceding tone pulses as well as forward and simultaneous masking effects of the high-pass noise suppress activity originating from those regions of the cochlea which are located basalwards to the region to be stimulated by the respective pulse, thus enhancing the frequency specificity, especially for low-frequency stimuli of higher intensity. The new stimulation paradigm was tested in 12 normal hearing subjects and turned out to be suitable to elicit frequency-specific ABR with frequencies as low as 500 Hz and intensities as low as 10 dB nHL. The main advantage of the described technique is that the time required for a complete assessment of the auditory threshold at seven test frequencies (covering the relevant speech frequency range) is substantially shorter as compared to conventional techniques so that it can routinely be employed in pedaudiology, where infants usually have to be investigated in sedation.