On the Use of Click-evoked Electric Brainstem Responses in Audiological Diagnosis: IV. Interaural Latency Differences (Wave V) in Cochlear Hearing Loss

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Abstract
Interaural latency differences (ILDs) of wave V of the brainstem electric response (BSER) were studied (1) in 20 normal-hearing subjects at 90, 80, 60 and 40 dB HL click level, (2) in 22 patients with symmetrical cochlear hearing loss at 90 dB HL, corresponding to 45–80 dB SL, and (3) in 45 patients with asymetrical cochlear hearing loss with interaural recruitment, at 90 dB HL on one hand and at a click sensation level corresponding to 90 dB HL in the poorer ear (range 10–75 dB SL) on the other hand. In the normal hearing group the ILDs did not exceed 0.2 ms except in one case at 40 dB HL (0.3 ms). In the symmetrical cochlear loss group the ILD did not exceed 0.2 ms in any patient. In the asymmetrical cochlear loss group the ILD at 90 dB HL exceeded 0.2 ms in 12 cases, but only in four cases after correction for pure tone hearing loss at 4 kHz by 0.1 ms for each 10 dB above 50 dB HL; at equal sensation levels the ILDs were all zero or negative meaning that the wave V latency was shorter on stimulation of the poorer ear. Assuming ILD to be a valid discriminator between cochlear and retrocochlear lesions, the corrected ILD at equal click hearing levels (90 dB HL), with the critical value set at 0.2 ms, thus gave a 9% false-positive rate whereas the ILD at equal sensation levels, with the critical value set at zero, gave no false-positives. It still remains to be shown that the latter criterion will not increase the number of false-negative results in retrocochlear lesions.