Abstract To the Editor.— Two articles in your journal about brain-stem auditoryevoked responses (BAERs) emphasized the importance of controlling technical variables in assessing BAER normal variability and defining BAER abnormalities. As shown in Fig 1, the intrasubject "waveform variations" reported by Chiappa et al1 can occur solely as a function of varying acoustic polarity (rarefaction vs condensation) of the click stimuli used. We agree with Chiappa et al that the morphologic variations they described are not clinically important, but suggest that other laboratories beginning to collect their normative BAER data control for the effects of click polarity, since it is a determinant of BAER interwave latency and relative amplitude norms2 (Fig 1), as well as of morphology. Our general findings and conclusions about normal BAER variability2 closely agree with those of Chiappa et al and, specifically, we have long concurred about the limited diagnostic value of waves VI References 1. Chiappa KH, Gladstone KJ, Young RR: Brainstem auditory-evoked responses: Studies of waveform variation in 50 normal subjects . Arch Neurol 36:81-87, 1979.Crossref 2. Stockard JJ, Stockard JE, Sharbrough FW: Nonpathologic factors influencing brainstem auditory-evoked potentials . Am J EEG Technol 18:177-209, 1978. 3. Stockard JJ, Stockard JE, Sharbrough FW: Detection and localization of occult lesions with brainstem auditory responses . Mayo Clin Proc 52:761-769, 1977. 4. Hashimoto I, Ishiyama Y, Tozuka G: Bilaterally recorded brainstem auditory-evoked responses: Their asymmetric abnormalities and lesions of the brainstem . Arch Neurol 36:161-167, 1979.Crossref 5. Starr A, Achor J: Auditory brainstem responses in neurological disease . Arch Neurol 32:761-768, 1975.Crossref 6. Stockard JJ, Stockard JE, Sharbrough FW: Variation of apparent central conduction times between brainstem auditory-evoked potentials as a function of peripheral factors: Implications for neurologic application of the test . Neurology 29:597-598, 1979.
Archives of Neurology – American Medical Association
Published: Sep 1, 1979
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