The document provides information about an Audiology Brainstem Response (ABR) test. It describes what an ABR test measures (electrical activity in the auditory nerve and brainstem in response to sounds), its main clinical uses (identifying neurological abnormalities in the auditory nerve/pathways and estimating hearing sensitivity), and the typical waveform characteristics. It also outlines two main patient groups that benefit from ABR testing - those with suspected neural problems and those who can't complete a standard hearing test.

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Parami General Hospital
NEWSLETTER
Issue 15 November, 2012
Holistic, Compassionate and Quality Health Care
Advisory Group Audiology Brainstem Response " ABR "
Prof. U Thein Aung
Dr. Shein Myint
Prof. U Khin Maung Aye
Parami Hospital - Yangon
Dr. Tin Nyunt
Prof. U Saw Win The Auditory Brainstem Response is most commonly abbreviated "ABR", but also
referred to as the BAER (brainstem auditory evoked response, BAEP (brainstem auditory
Prof. Daw Mya Thida
evoked potential), BER (brainstem evoked response), etc. The ABR represents electrical
Prof. U Ne Win
activity generated by the eighth cranial (vestibulo-cochlear) nerve and neural centres and
Editorial Board tracts within the brainstem that are responsive to auditory stimulation.
Dr. Myint Lwin The ABR has primary clinical application in two areas :
Dr. Shwe Baw (a) Identification of neurological abnormalities in the eighth cranial nerve and
auditory pathways of the brainstem.
Dr. Zay Ya Aye
(b) Estimation of hearing sensitivity based on the presence of a response at various
Dr. Shein Myint
intensity levels.
Dr. Tin Moe Phyu
The ABR is most robust in identifying tumours of the eighth nerve that are greater than
Dr. Khin Than Htay
one centimeter (cm), whereas less success has been experienced with diffuse demyelinating
Dr. Thida Oo disease like multiple sclerosis.
Dr. Nyein Moe Thaw There are two primary groups of patients who will benefit from ABR testing :
Dr. Hnin Thuzar Aung (a) Those patients with suspected neural problems.
Contact Us (b) Those patients for whom accurate behavioural evaluation of hearing sensitivity
No-60, G-1, is not possible.
New Parami Road, A normal ABR waveform is characterized by five to seven vertex positive peak that
Mayangone Tsp,Yangon, occur on the time period from 1.4 to 8.0 multi second after the onset of a stimulus.
Myanmar. Thus, wave (I) corresponds, to recording from the distal position of the eighth nerve
Tel : 651674, 660083, and wave (II) originates mainly from the proximal position of the eighth nerve with a possible
657226, 657228, small contribution from more distal positions of the auditory nerve.
657230 to 657232 Recording from the cochlear nucleus correspounds with the surface-recorded wave
info@paramihospital.com (III), suggesting that wave (III) is generated mainly by neurons in the cochlear nucleus,
Free Distribution
with possible additional contributions from fibres entering the cochlear nucleus. The neural
The contents of the
generations of wave (IV) are uncertain, although third order neurons in the superior olivary
newsletter are not to be
complex are most likely involved; other contributors may include the cochlear nucleus and
reproduced in any form
the nucleus of the lateral lemniscus. The wave (V) may be related to activity in the lateral
without prior written
lemniscus and inferior colliculus, but it should be emphasized that peaks IV, V, VI and VII
approval of the
of the ABR are complex, with more than one anatomical structure contributing to each peak
editorial board.
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2. Issue - 15, November 2012 Page - 2 Parami Hospital - Yangon, Newsletter
I’ll report this……!
D ay in day out! It’s not easy to travel daily by bus. But when one doesn’t own a car, there’s no way but to take
a bus to get to your destination!
The start of another day! By 8 o’clock, lunch-box in hand, May starts her day – she walks out to her bus – stand,
a few kilometers away from her apartment. Actually, she lives in an eight-storeyed building – her apartment being in the
topmost floor. She has to make sure she doesn’t forget to bring along everything as she left home. Or else, she might
have to run up the stairs again to pick up whatever she has forgotten to bring along with her, making her all in before she
could even go to the bus-stand.
Once at the bus-stand, she has to wait for sometime– noticed the scarcity of the passengers. It took some forty-
at least ten minutes before the bus she usually catches comes five minutes to reach the bus-stand where she should get
into view. She lives in down-town. Usually she used to off to reach her office. She was engrossed in her thoughts,
go to the university by the school-bus. But now she has happy and content with her endeavour to help the office
graduated and has started working in a newly established girls at work – imagining herself as an outstanding worker,
company. Her work takes her daily (except Sundays) to the reaching the office earlier than others and organizing her
outskirts of the city. staff. No, she had not forgotten she was in a bus. She was
She is happy. In fact she is feeling on top of the not used to going to this surrounding where her office
world! Who wouldn’t be happy when one gets a job a few was and she had a time trying to remember the bus-stand
months after one’s graduation. And it is a new office – a which preceded the one that she should really get off. It
new company – everything new! Her job starts at nine in is common practice to walk to the bus doorway when one
the morning and finishes at five in the evening. She has reaches the stop preceding the one where one should get
to work six days in a week. Naturally she does not have off, to be ready to get off when the bus stops at the next
to work on Sundays and of course neither on government- stand – one’s destination. No bus drivers nor bus conductors
gazetted holidays. would find time for passengers who are slow and not active
It was one gazetted holiday – a religious day: a full- enough to jump into the bus or off the bus – they are all
moon day when Myanmar people celebrate their kasone in a hurry to do their chores of bus-round and overtaking
nyaung-yé-thun festival. It was a holiday for May’s office their fellow buses.
too. But she must go to the office – she needed to help her Soon the bus rushed passed many bus-stands and
junior colleagues who were engaged in cleaning up the new May could well remember that she was almost there – her
office. She caught the bus after waiting for sometime at office-building, but she did not hear the bus conductor shout
the bus-stand. There were few people in the bus because it the name of the bus-stand she was to get off. Anyway, the
was a holiday but those inside were well-dressed and some bus usually let down the passengers at the crossroads where
were equipped with bouquets of flowers: only then did she the traffic lights turned red. She stood up from her seat and
remember that it was a religious holiday. She got a seat in walked to the bus doorway although the bus was not at all
the front line at the back of the driver and she no longer (To Page - 4 _____ )
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3. Issue - 15, November 2012 Page - 3 Parami Hospital - Yangon, Newsletter
" Rules For Living As A Good Leader "
1. Lead by example from the front of the formation. could be you and either your thinking or your
Take your performance personally – if you are proud communication skills. Likewise, sometimes the best
to be average, so too will be your troops. ideas come from bottom-up information sharing (i.e.,
2. A leader must provide a vision – clear and achievable "Need to share" not "Need to know"). Use "directed
'' big ideas " combined in a strategic concept – and telescopes" to improve situational awareness.
communicate those ideas throughout the entire 9. Leaders should be thoughful but decisive. Listen to
organization and to all other stakeholders. subordinates' input, evaluate courses of action and
3. A leader needs to give energy; don't be an oxygen second-and third-order effects, but be OK with an
thief. "80 percent solution." "There will be many moments
when all eyes turn to you for a decision. Be prepared
4. There is an exception to every rule, standard for them. Don't shrink from them. Embrace them."
operating procedure, and policy; it is up to leaders Sometimes the best move is the bold move.
to determine when exceptions should be made and
to explain why they made them. 10. Stay fit to fight. Your body is your ultimate weapons
system. Physical fitness for your body is essential for
5. We all make mistakes. The key is to recognize them mental fitness.
and admit them, to learn from them, and to take off
the rearview mirrors – drive on and avoid making 11. The only thing better than a little competition is a lot
them again. of competition. Set challenges for your subordinates
to encourage them to excel.
6. Be humble. The people you'll be leading already
have on-the-ground conflict experience. " Listen and 12. Everyone on the team is mission critical. Instill in
learn. " your team members a sense of great self-worth-that
each, at any given time, can be the most important
7. Be a team player. " Your team's triumphs and failures on the battlefield.
will, obviously, be yours. " Take ownership of both.
8. Don't rely on rank. If you rely on rank, rather than Ref : Lessons on leadership from General David Petraeus.
on the persuasiveness of your logic, the problem By Paula Broadwell.
Omega-3 may help struggling children to read, says study
C hildren with the worst reading skills could improve their literacy with daily supplements of fatty acids found
in fish, seafood and some algae, researchers claim. Scientists gave a daily 600mg omega-3 fatty acid pill to children aged
seven to nine and found that those whose reading skills were in the lowest fifth of the normal range improved over the
four months of the study.
On average, the children in the bottom 20% for literacy boosted their reading age by three weeks more than a
control group taking a daily placebo. Those in the lowest 10% for literacy improved their reading age by 1.9 months
compared with the placebo group. The study was funded by a company called DSM Nutritional Lipids, which makes
omega-3 supplements, though the study was performed at Oxford independently.
Ref : http://www.guardian.co.uk/science/2012/sep/06/reading-fatty-acids-controversy

4. Issue - 15, November 2012 Page - 4 Parami Hospital - Yangon, Newsletter
onto it, the bus had swayed and swerved in trying to overtake
Continued from I’ll report this……! (Page - 2) theone in front.
slowing down at the crossroads. Perhaps the traffic lights “Yes, I’ll report this!” she shouted again and looked
were still green, she thought. But even as she walked to up at the bus which had disappeared from her view – too
the doorway, the bus did not come to a halt at the oncoming late, she had not even noted down its ‘registered number
bus-stop that she was to get off: plate’……..! - ktt -
“Stop! Stop! This is the stop I am to get off!”, she
Continued from Audiology Brainstem Response
raised her voice in distress, but to no avail. Surprised, she
" ABR " (Page - 1)
looked at the direction of the conductor who did not seem to
care at all, “You did not get up from your seat in due time. and each structure contributing to more than one peak.
You can catch the return bus, it’s quite easy”, he muttered. The only obligatory synaptic sites in the human brainstem
May stared at the bus conductor, and suddenly burst pathway are the cochlear nuclei and the inferior colliculus,
out in anger, “Why don’t your bus halt at the bus-stop? It’s a and between these pathways there are series of parallel
job of every bus to stop at the bus-stop! I am going to report pathway.
this!”. Her eyes wavered onto the inside of the car’s However auditory evoked potential provides
roof {the bus’ ceiling} searching for the phone number powerful, objective methods of assessing the neural integrity
allowing passengers to send a complaint; this being usually of the auditory pathways from the eight cranial nerve to the
present in buses. But here she could not find it. This made cortex.
her more frustrated: “I’ll report this to your headquarters! Figure showing Normal ABR waveform responser
How dare you do like this! Give me back the bus fare”. She
shouted at the top of her voice oblivious of the passengers
whose eyes were on her. The conductor was surprised: he
seemed to think it was no problem for one to catch back a
bus just for one stop! But May was angry especially because
she had wanted to reach her office early, earlier than the
appointed time! Now, with the time wasted to catch another
bus, how could she reach the office early? Not easy even
to arrive in time!
She jumped off the bus when it came to a halt at the
next stand. But even as she did so, she felt a sensation of
dull pain in her left knee - " Ah-h-h! ", she landed in a limp
making her more angry as she remembered the day before
yesterday when she was injured as she caught the bus to
Ref: (1) Hood, L.J (1998)
go to her new job: she had landed on all fours at that time Clinical applications of the Auditory Brainstem Response.
as she got into the bus because soon after she had stepped Singular Publishing group.
(2) Katz. J. (2002). Handbook of CLINICAL AUDIOLOGY
Lippincott Williams + Wilkins.