ABR Waveform Analysis

···············~···················+: . . . . Ll-111 : LIII-V :

·············~···················+: ............... ~ ................... ..;

···························+: Lv

i . ··~·~·~

"' Stimulus artifact

: Pre-stimulus

CHAPTER 7 ABR ANALYSIS AND INTERPRETATION

Absolute Latency 1=1.5ms Ill =3.5 ms V = 5.8 ms

lnterwave Latency 1-111 = 2.3 ms 111-V = 2.0 ms 1-V = 4.3 ms

Absolute Amplitude I= 0.40 11V V = 0.75jlV

Amplitude Ratio VII = 1.85 11V

80 dB nHL

213

baseline - t ......... . ....................................................................... ,.: . v

' ==: 3,.:'"(~ir~ -1 0 2 3 4 5 6 7 8 9

Latency in ms

Steps in the simple analysis of ABR wave latency and amplitude.

V amplitude, also illustrated in Figure 7. I. A third calculation of the difference in amplitude between

-·v"'"'"" of the wave and some measure of a baseline rarely applied in analysis of ABR waveforms. This

is, however, commonly used in calculating the ratio components, such as the ratio of amplitude for

••~y~.uu summating potential and action potential, or in the absolute amplitudes of later latency auditory

"'~''moe.,, e.g., AMLR, ALR, and P300 response, as . in subsequent chapters. The most commonly cal­relative amplitude measure in ABR analysis is the

wave I ratio. Normally the value is at least 1.0, or _,11,,r~h'lv larger (as shown in Figure 7.1 ).

final fundamental concept in ABR waveform analysis ~tdirect:ion of response polarity- that is, which way is

of an ABR is dependent on the electrode loca­te the generator of the response and, of course,

-"~'u-''"'"·'"'u" is plugged into the positive and negative nputs of the differential amplifier. The clinician

major waves of any ABR as negative or positive

in voltage depending on which electrodes are plugged into which amplifier inputs. For most ABR recordings, the elec­trode located at a high forehead (or vertex) site are plugged into the positive (noninverting) voltage input of the ampli­fier, and the electrode located near the ear (e.g., earlobe) is plugged into the negative (inverting) amplifier input. With this approach, the resulting, and familiar, ABR waveform is characterized by positive voltage peaks (e.g., waxe I, wave III, and wave V) plotted upward and the negative voltage troughs plotted downward. This convention for plotting waveform polarity is not followed consistently, however, as some investigators in Canada, Scandinavia, Israel, and the United States (e.g., Picton, Terkildsen, Sohmer, and Mlllller, respectively) show these characteristic waves plotted "upside down," that is, with positive voltage downward.

One must keep in mind that the ABR waves do not adequately describe all underlying neurophysiologic activ­ity produced by the stimulus. As emphasized in Chapter 2, the relation between ABR waves and anatomic generators is complex and not entirely understood. E lectrodes located

...

Leigh Am Salabier

SIIUirtEP ASSR OAE VRA

'1 tnBIJGBfTIIAPI& 1111111

6810 sw 81st Street -.mt, Fl«<ccl 33143 ~102 •1.....,...YI~· www.lhsys.com

10: IHS3838-20112101 Page: Al::q Testllrilllr. Feb. 01,2011 Age: (DOB amply) Report Feb. 01,2011

~~··-- / 6-60~{A} , -·-c ", "~p· . '"-:

Lllfency (ms)

11 10 q

v -~ , '· \ J

-(

0 1 8 :2._ 3_ 4_ r-5 _6 f- 7_ 8_ 9_ 10_ 11 12 ms 0 2 3 4 5 6 7 8 9 10 11 12 ms

7

6 5 4 3 2 1

-...: ~ "l!!'. t~ ... ·-., v

Ill

I I 8 1 0 ZO 30 48 50 60 70 80 90 1 00

Intensity (dB Hl.l Age: Unknown

SmartEP ASSR OAE VRA

INTfWGOO HaNN6 11111111

6860 SW 81st Street Miami, Florida 33143 305-668-6102 • 1-800-IHSYSTEMS • www.ihsys.com

leigh Ann Sauerbier 10 : IHS3638-20112101 Page: Acq Test Date: Feb. 01, 2011 Age: (DOB empty) Report: Feb. 01, 2011

Num Filename lnt Ear- Stirn. Type SwpsiM Rate Mode PPAmp r LSRA80A.1 80nHl R lnst Clicll 200011 21.1 Rare 0.94 2 LSRABOA.2 80nHl R lnst Clicll 2000t'O 21.1 Rare 0.93 3 LSRABOA.3 80nHl R lnst Clicll 2000144 71.1 Rare 0.71 4 LSRABOA.4 80nHL R lnst era 2000129 71.1 Rare 0 .80 5 LSRA60A.1 60nHL R lnst Click 2000/ti 21 .1 Rare 0 .66 6 LSRA60A.2 60nHL R lnst Clicll 2000/ti1 21 .1 Rare 0 .-46 7 LSRA40A.1 40nHL R lnst Clicll 2000111 21 .1 Rare 0 .47 8 LSRA40A.2 40nHL R lnst Clicll 200014 21 .1 Rare 0 .39 9 LSRA20A.1 20nHL R lnst Clicll 2000153 21 .1 Rare 0 .47 10 LSRA20A.2 20nHL R lnst Clicll 200012 21 .1 Rare 0 .20 11 LSLA80B.1 80nHL L lnst Clicll 2000113 21 .1 Rare 0 .62 12 LSLA80B.2 80nHL L lnst Clicll 200012 21 .1 Rare 0.67 13 LSLAS08.1 60nHL L lnst Click 2000112 21 .1 Rare 0.50 14 LSLAS08.2 60nHL L lnst Clicll 2000112 21.1 Rare 0.48 15 LSLA40B.1 40nHL L lnst Click 200011 21.1 Rare 0.30 16 LSLA40B.2 40nHL L lnst Click 2000110 21.1 Rare 0.33 17 LSLA20B.1 20nHL L lnst Click 2000/ti4 21 .1 Rare 0.58 18 LSLA20B.2 20nHL L lnst Click 2000113 21 .1 Rare 0.36 19 LSLA80B.3 80nHL L lnst Click 2000t'O 71 .1 Rare 0.76 20 LSLA80B.4 80nHL L lnst Clicll 2000/ti 71.j Rare 0 .62

System SNR & RN Region: 4.00 - 9.00 ms (")-indicates different region used

Num lnt 1 80 2 80 3 80 4 80 5 60 6 60 7 40 8 40 9 20 10 20 11 80 12 80 13 60 14 60 15 40 16 40 17 20 18 20 19 80 20 80

Ear R R R R R R R R R R L L L L L L L L L L

Peaks: lalency(ms) I Amp(uV) (AR=Amp Ratio) 1: 1.60 1 0.39 Ill: 3 .581 o.oo

1: 1.55 1 o.oo II: 3.50 I 0 .00

V: 5.451 0 .92

V: 5.551 0.00 V : 5.70 I 0 .00

V : 6.30 I 0.00

V: 7.40 I 0.00

V: 5.28 I 0.00

V: 5 .45 1 0 .00

V: 6.151 0.00

V: 6 .90 I 0.00

V : 5.50 I 0.00

11-1: 1.981 0 .01AR

111-1: 1.951

SNRRN Gain Filters 6 .89 0.07 100 100-3000Hz 2.36 0.20 100 100-3000Hz 2.11 0.17 100 100-3000Hz 2.48 0.16 100 100-3000Hz 2.19 0 .16 100 100-3000Hz 0.84 0.25 100 100-3000Hz 0 .73 0 .34 100 100-3000Hz 1.11 0.23 100 100-3000Hz 0.92 0.26 100 100-3000Hz 0.51 0.15 100 100-3000Hz 2.74 0 .11 100 100-3000Hz 1.12 0.26 100 100-3000Hz 0.76 0.32 100 100-3000Hz 1.45 0.14 100 100-3000Hz 0.89 0.18 100 100-3000Hz o.n 0.25 100 100-3000Hz 0.41 0.48 100 100-3000Hz 0 .97 0 .20 100 100-3000Hz 1.51 0.23 100 100-3000Hz 0.64 0.45 100 100-3000Hz

V-11: 1.881188.93AR V-1: 3.85 12.36AR

V-III: 1.781 V-1: 3.731

Last MediD: Date: ffl/1~

Case History:

Syosset Speech and Hearing Center l75 Jericho Twnpike

Syosset, New Y o1X 11791 (516)- 364-1234

First: D.O.B.: 12/6106 Examiner. T.GORDON,PH.D

RULE OliT AUDITORY NBUROPA'OIY

Notes/Impression:

ABRinsens I I

R.r lid:FAc_, tOI'>i II

i\ A II! A rv IJ \; v ~ I \ v v--~· 9 (\

hi V\ l/'v r---J

£iT t 1) /Jb tNS-1 1io rV

~ --v ~ r\ l \

~ '( /": ~

"'\ v ~

V'

\M \I' \.., vv

5

-v I )\ At-1i fi4.i t ~-n/\ G-

.... v vd B ,..,

--t-V\; \J ~ /\ / r----/ ...., 3

IDaert Pbme Dly: 0.90 1llleC _ bertPbolle Dly: 0.90 msec

Sex: M

I

Ktr ~F (tel oN

"'-/ v ~ ~ v 2

C.i ~N rt pJs;) Ffl C rv

r-------1--- 6

rtL rru PrTA lf6-I - f---.. -

3 lo.62 uV 1.0 maec 4 lo.62 uV 1.0 maec s ~062 uV 1.0 msec 8 62 uV 1.0 maec 9 lo.62 uV 1.0 QUeC t2J0.62 uV LO msec

SUFFOLK OFFICE: . 0 ARTHUR PODWALL, PH.D. & ASSOCIATES

267 EAST MAIN STREET, STE. 1 B

SMITHTOWN, NEW YORK 1 1787

(631 J 360-3222 FAX (631 l 360-7477

PATIENT'S NAME

-1 0

0

0

_J 2 I

fl5 3 ?; _J 4 UJ

~ 5 _J

0

0

0

0

g 60 0 V5 70 UJ

~ 80 1-<.:l 90 z cr100 <1: UJ

, , 0

120

PURE TONE AUDIOMETRY (RE: ANSI 1969)

<' ~ / "~ /"

" ~'"",

-'"· -~ p r<'$ ~

1; ~ ~ ~--".":. ll"-::; 'S,( ..... ~-..

"' V\,_, K>< ~ ~ X ?.)..

\...:.

"'""' '<:: D"

125 250 500 1 000 2000 4000 8000

-.,.. _____ 750 1500 3000 6000

FREQUENCY ------4-SPEECH AUDIOMETRY

RIGH

NASSAU OFFICE:

0 SYOSSET SPEECH & HEARING CENTER 175 .JERICHO TURNPIKE, STE. 103

SYOSSET, NEW YORK 1 1791

(5161 364-1234 FAX (5161 364-3132

9/17/2009 P. Lamendola M.S. DATE

2.0

1.8

1.6 _J

~1.4

z ;:;J 1.2 ()

~ 1.0

cr .8 ~

8 .6

.4

.2

0

iT n>~ ~,i ,T ~~ ~~

AUDIOLOGIST

TYMPANOGRAM

!

FYl ~pi Pl' gi ~ 11~

f-FY PP ~( gJ laD llj:>

[;\ ~J R I./ v ......._

~ L'--. I I'--

l AGE

-t'--600 -500 -400 -300 -200 -100 0 +100 +200 +300

TYMPANOMETRY RESULTS R L EAR CANAL VOLUME mi. J.Z. ,::z; STATIC COMPLIANCE mi. ·S" .~

PEAK PRESSURE daPa fJ -CZ5a LEFT GRADIENT .lf ·2-

SAT SPEECH SPEECH ~ LEGEND (RED) (BLUE)

ACOUSTIC REFLEXES RECOGNITION RECOGNITION l

RIGHT % dBHL % dBHL

~ (AD) 4o 08 1c:; 5& L~£ .C4

LEFT % dBHL % dBHL

~-(AS) J5 g. A 1o ?%- Cfs"' 0 t"..-e lA,,

AIR 0 X

AIR

(MASKED! 6 0

BONE < >

BONE [ J I MASKED\

NO RESPONSE -J,- -J,-

PROBE RIGHT .5kHz 1kHz 2kHz 4kHz NOISE

IPSI- RIGHT B~ ~ I~ 1\lz_.

CONTRA- PHONE LEFT 85 Cj$5 }O'U ~ PROBE LEFT .5kHz 1kHz 2kHz 4kHz NOISE

IPSI- LEFT q&' Cfo Jt)r-~ CONTRA -PHONE RIGHT 16D 96" 7lE IA.fe

% dBHL % dBHL

\ SOUND FIELD

AIDED

REFLEX DECAY .5kHz 1kHz

CONTRA - PHONE RIGHT -J CONTRA - PHONE LEFT -=::.)

HEARING AID INFORMATION RIGHT: . ___________________________ LEFT: __________________________ __

Syosset Speech and Hearing Center 175 Jericho Turnpike

Syosset, New York 11791 (516)- 364-1234

First: JOEL D.O.B.:~ Examiner: T.GOROON,PH.D

Sex: M

Case History: CONSISTENTLY POO~R SRS AD DESPITE SYMMETRICAL PURE TONES.

Notes/Impressions:

Insert Phone Dly: 0.90 msec

1 0.16uV l.Omsec 2 0.16uV 1.0 msec 4 0.16 uV 1.0 msec 5 0.16uV l.Omsec 6 0.16uV l.Omsec 130.16uV l.Omsec

~--~( <RR R.l6tf-7 ..._

I 1.46ms Illl 2. 16ms I 1.42ms I- m 2.20ms m-v 1.88ms m-v 1.88ms

II 1- V 4.04ms II 1-V 4.08ms ill 3.62ms -- m 3.62ms -IV VII IV VII v S.50ms RaoidV- V 0.44ms v S.SOms Raoid V- V 0.36ms - -RaoidV S.94ms Raoid v S.86ms v - v O.OOms v dB v dB I- V - 1- V 0.04ms v dB v dB

50uV 100 3K 50uV 100 3K 50uV too 3K 50uV tOO 3K 50uV tOO 3K

Run 50uV too 3K Run 50uV tOO 3K RIDI 50uV tOO 3K

_ACQ 1 1500 11.1 2 1500 11.1 Inter 3 1500 Oms 11.1 Inter 4 1500 Oms 11.1 Inter 5 1500 Oms 71.1 Inter 6 1500 Oms 71.1 Inter 9 t500 tOms Oms 71.1 Inter 13 t500 tOms Oms 71.1 Inter

sert Click Rar sert Off ert Click Rar 100us 9.5

sert Off sert Off ert Off

lOOus 95 100us 95

Syosset Speech and Hearing Center 175 Jericho Turnpike

Syosset, New York 11791 (516)- 364-1234

ABRinserts

emarks 1 2 3 4 5 6 9 13

iSNR Dare Time Add Sub In:!' Filter Smooth t 1500 1 1.51 W/21/09 14:02 no no no Linear no 2 1500 1 0.55 W/21/09 13:49 no no no Linear no 1 1500 0 0.92 W/21/09 14:05 no no no Linear no 2 1500 0 0.92 W/21/09 13:51 no no no Linear no 2 t500 83 0.69 W/21/09 14:00 no no no Linear no 2 1500 29 0.73 W/21/09 14:00 no no no Linear no

Gated t t500 0 1.05 W/21/09 14:13 no no no Linear no Gated 1 1500 0 l.Ot W/21/09 14:14 no no no Linear no

I Ereq Ela Ramp&:!' No.i Nl.ey dR Off ert Off Intern 0 nHL InternO sert Click Rar 100us 95 Off nHL Off ert Off Intern 0 nHL Intern 0 ert Click Rar 100us 95 Off nHL Intern 0 ert Click Rar lOOus 95 Off nHL Intern 0 ert Click Rar lOOus 95 Off nHL Off sert Off Intern 0 nHL Off sert Off Intern 0 nHL

Jun-22-2005 10:30am From-

Last: ,,., Med ID: 2650346 Date~: 05131/2005

Casu History:

NoteSJI mpressions: See report.

Elmhumt Hospital Center 79-01 Br~tdway

Elmhumt New York 11373 SPE1e1:h & Hearing

First:~ Birthdate: 4/14/J'OS Examiner: c:. Hochman

Ton4~ ABR Ri!; ht

-~---:--"Sgn!i!iv!!y=·,.,· .!!L.!<ili<I""-'<&M!!!'!£.tlm8f~D.!l1sllln 1 '

10.15u'i 2.01\'!Me ~~ll.15uV :Z.OIMeC 311l1SQI/ 2.0mMQ

Ofi 0.1$uv :?.0-."* 0 0.15w 2.C m88e 7 ll,151h' 2.0111&41C Insert Phont!• Oiy: .90 msec

l.A'~~ Jrof(ii0)~00)51TY I LV("IOO) , LV(!IO) LVi80) RV(~ LVi70) 0 14m& ~V(7Q)

!LVi6QI RV(OO) jLV(501 a.74m& RV(SO) ,LV(-401 RV(-40) ILV(301 11.18MO; RV(30)

~~ 12.C8m1. 41'1'RVu;(20')1Ul...------'

T-494 P.OOZ/005 F-563

Gender: M

410.15ul! 8 0.15 u\'

2.0meec 2.omsee

I l

Jun-22-Z003 >0:30am From-

•-.i

-"~(~~; -~_? ~~~~~ ~sK-2 Cr.M R.ll'l '41\1 $0 1,SK 3 C:-A 1 Ru~ 50\lV SO 1.61( 4 , Cv,1.1 Run l:OIIV :lU 1.5!( 5 I Cz-.~1 R•n !lOIN 30 1.!1< s ~ .. ..., R~>n ~ow &J 1.SK 7 . Cr-A1 'lun SOW SO 1.5K 11 I Cz-A1 ~~~~~ !iOuv ;;o 1.SK

r~h

00 Olf 011 011 011 Oft Off 011

ACO 1 ec~m & .... •ILI!!D.!..~i!:L.l!~~~ 1 I A ::!(JO(l 2tl11'11i llln• 31.5 ~r G&ted 2 A ::!(00 20ms Oms 31.5 h'll;r GJI!Jd 3 • A 2Hl0 20ms Or~~:a g1.S lnlBr ~ 4 I" 21:00 !ltlmt Oms :!11 .~ 111'-r ~ 5 A 2CQO 20-na am,. 31 ~ fn1l!r ~ted I! ·A 2(00 20'1'1$ Om:i ~1 .5 IIUM iJIT8d 7 I A :2COO 20-m Omli 31 s ITllr:r Ga!B<I 8 \A 2tOO ~116 Ornn 31.5 Inter Gau.d

Artlfallt iiil eo 90 QO 110 90 PO flO

Elmhur::;t Hospi·:al Center 79-01 Broadway

Elmhunst, New York 11373 Spe:e·oh & Hearing

Ton'~ ABR Ri{lht

REM I Remt~~tks

II

~ I e , ~ I

r.<~'lC~T~_C11~ Aa:oof!!.~~-_Fitlzlr f!PISNR Dill\' 11m.~ 1 11103 0 8Uiiii 31.211 OSIJ1f.2005 12.01l

2 , 5~1!'. 1 ISM 0 Bue.r 2S.II2 0Sf.>1QCQS 12:10 3 I S)m 1 11011 ! EW!IIor 2361 05131a<X:\$ 1Z11 4 , Sum 1 151:'.1 o oa.- nre 0513112005 12:~2 5 1 s~"' 1 :2000 o a~lOf ~. 09 0513112005 ~z1s B I s~m 1 17:1$ 2 !Micr 2.511 C~1/2C05 lZ 14 7 Sum 1 2000 0 131111er 1.-48 0SrJ112W5 1~;'S 6 , sum i 2000 o I~LIIIIW 1.~ 0513112005 12:16

T-494 P 003/005 F-563

t.o!~l.!!LE!!!!..!il!!!'!!!ltl IQ no 1'10 r.c; no na nil no !1Q no ~b no no no ""' nt:l no no no "" n~ no n(l no no n~ riP 00 ~0 no na no no no no no no nQ ng ft(l

sn.~~!....~-2!L-1!MIII F~~P-"n• Noi 1 lnt1:1rt Tr;m" o,tt 70 ~ 0::!• 2 all(1Sif

~~~~-"" 116 I Tra•J!!'_):YJ!!L li'oi_...QJ!L l,e:.!i Frea PI'!- Ramp , .,. nf.IL lnalrt 011

Noi NLCN d8 i;;te;;;-b--nHL

2 Insert Tor~ 'IR 70 SOOi-12 0cy 2 81~ Off nH~ ln&lrt 011 ffiUo'l'\ 0 nHL ;! lnoort 'rt.ri!J .~t 50 SOOHl Oc)' 2 ElUt Olr 4 llnseli Tt>ta ,,It 5C 5!nU Oc)• 2 etl< 01r 5 Insert TO<'e ·~k 3G ~ IJcl' :! E\lk Ofr 6 tnllllt Tore ,lJ: 3C roi:lH.l Oc\' 2 elk 0'11' 7 inGerl Tat•o ,,n 20 :iOili-U (),~· 2 91k 011 ll l maell TcnQ .\~ 20 5llOHl: Oc)' 2 Blk Olf

nHl IRIIlilrt 00 nHI.. lt~t;srt Off nHL lnanrt :ltf nhL ll'l!lu!t ·~ ntil , ... lit~ nHL , lnSIIIt •:)If

lnlem I') nHL lr.&anl Cl nHl kltiJm 0 tlHL 1~'-im 0 fHL lntem 0 ~HL

"'~ 0 rPIL

Jun-Z2-ZOOS 10:31am From-

Last: ·-Med 1[:1: 2650346 Date·: 05131/2005

caso His1ory:

Notes/1 mpressions: See report.

Elmhumt Ho:spital Center 79.()1 Bro~1dway

Elmhumtl New York 11373 SpEIE!rj1 & Hearing

First: 8llfi/ Birthaate: 4//4/J'OS Examiner: G. Hochman

TonE' ABR Right -

. .

T-494 P.004/ 005

Gender: M

t I I I I I

F-563

O.<Oms 0.04 u'r

6

t • t 1 a a , ' , .. .. ______ ___ .. ,. .................. , .... ________ -·~· ...... -- --- __ ,_ --"· -· • ..~ .. -- .. --··-- -- -- ..... .,. .... __ -------.-- .. --- ... .. ·-~~~~·· ·- -- ------"1-- ... -...... .... ,. -.. . I I f I I 1 I f ' I I I 1 • 1 ' I I ' I I I I I

Z.Omsec : : : : O.lSuV Nicolet --I I I 1 I

.._ _____ ......... ....._ ____ __....._ ____ .._ ____ ...._ ____ _._ _______ __.

~--------------------~~~=~i~~·~~a~~~Swe~~~rows=~~"~~--------~~~~~~------~~~~~~ 1 j0.15uV 2.Dm::,., 2j0.15uV 20nr.IIIIC: 3j0.15LIV 2.0m~M~C 4 IC.1t;u\' ~Om&e<l SI0.15~V 2.0m&ee tljD.15 W 2.0m5e~

Insert Pho1le Dl';o: 0.90 msec t..ATe:NI~ rN'IS!i~Y.;...K::,__ ___ , LV{'100) L'itwl lV(80) LV(70) LV(liO) LV(SO) LV(-40) LV(llO) LV(20}

IJ,.'lt1Q)..

RV(iOO) RV(tiO) FtV(liO) R\I(Tll) FtV(SO)

7.~rna RV(~;()) 'RV(~

6.78nv.

10.10ms --

Jun-22-2005 ;0:31am From-

' ..

fiNP I Sleet I ~odt< 8.'16 Lf! Hn ~.oletl -n~-iilll'l SOIIV :lO 1.5k Clf

2 Cz-A1 il•n $l\JV 30 1.5K Off 3 ~~~ llun 5DuV 30 1.51< O!t 4 CZ.A1 itu" souv 30 1.SK Olf 5 CZ.A1 't~n 50uV 30 1.5K ctr f Ct.Al 'l~n SOuV :10 1.51< Olt

ACS I Coto~m Slo'!!:!' ti~~!'X Rate T~.2!l!n 1 \ A 20JD 20<ns Oms 31.5 Inter ~ 2 " 20Xl ~~ Om!! 31.5 Inter G<lled 3

I~ 20Xl 20rn& OMit 31,:; Inter G..wa

4 20!0 2orna ~ 31.5 l!lh!I chled 5 l A 20!0 20m& Oms 31.5 h'lll)f' o-0 l A 201l0 :!IJM15 llms 31.5 lrlU!r Caled

S'!IM ' Trans-~!_''!l!_..Jlur LewlF!JSI Pia Ram 111101t cl\• 'Ill 50 :li<Hz Oey l

2 ln..ert To~. .IJt 60 2KHz Dey 2 3 lnMit T~r>t t,lt 30 2KHz Qqy 2 4 I!IBM Tgm ,IJt 30 2KHz Oc'j 2 s ln""rt T""'l .'l! ;!0 2~ Dey 2 $ I i(ulort ToM )' ,It 2C 2KHz Dey 2

Elmhur!lt Hospital Center 79--01 Broa~dway

Elmhur!it, New York 11373 Spee<::h & Hearing

Tom~ ABR Right

A~~ Tl·-IJ)

90 ao 90 90 ~ I 00

l-\ISCI 1 SIUll

B!J~:li..f!lr_~~\11 T!!!l6 o Elum!r 5.21 osmt.iOI)$ 12:19

2 Sum 1 !lull&r :<.43 0513112005 , 2:20 :'1 .Sum 0 ULI!b!ot 6.88 oev.l1nao5 12Z! 4 &Jrn I) Elutlor 1.72 051:)1 /2005 12:23 G Sum 0 EIUI!oor ~.81 05t:11/2.005 12!20 $ Slim 0 Ellll\8r 0.18 CSI31fi006 12;28

E"" Nol Nltw dB .I!!!t& ;-ype P2J g~r i..r>lol "''!!9 PJ~ Blk Oft n ~ !~*It Of! Blk 01f 1111!. ln&e.t C)lf Bik 01! nHL 1'"""11: Clf! SJk 0!1 nHL lmert. Dll Blk CM nHL lnillrt Clll Bll< 01f nHL / lnflerl Ott

i-494 P.OOS/005 F-563

A-lei Suo lnv Flll1l~ SlnCX>Ih llo ,.. no '10 no no no no no no no no "" ng 1!0

r.o 110 no ~" no flO nc 1'10 II(> no no Ml o g no no

R~s:,, ~ I>IUtv dE!_ trr'.am 0 n'il. lnll!r~ (l nHL lr'tbom 0 t'IHL Intern 0 n>tl lmem o nH~ lnll!rft o nHL