Acoustic Change Complex: Clinical Implications

The acoustic change complex (ACC) is a cortical auditory evoked potential elicited in response to a change in an ongoing sound. The characteristics and potential clinical implications of the ACC are reviewed in this article. The P1-N1-P2 recorded from the auditory cortex following presentation of an acoustic stimulus is believed to reflect the neural encoding of a sound signal, but this provides no information regarding sound discrimination. However, the neural processing underlying behavioral discrimination capacity can be measured by modifying the traditional methodology for recording the P1-N1-P2. When obtained in response to an acoustic change within an ongoing sound, the resulting waveform is referred to as the ACC. When elicited, the ACC indicates that the brain has detected changes within a sound and the patient has the neural capacity to discriminate the sounds. In fact, results of several studies have shown that the ACC amplitude increases with increasing magnitude of acoustic changes in intensity, spectrum, and gap duration. In addition, the ACC can be reliably recorded with good test-retest reliability not only from listeners with normal hearing but also from individuals with hearing loss, hearing aids, and cochlear implants. The ACC can be obtained even in the absence of attention, and requires relatively few stimulus presentations to record a response with a good signal-to-noise ratio. Most importantly, the ACC shows reasonable agreement with behavioral measures. Therefore, these findings suggest that the ACC might represent a promising tool for the objective clinical evaluation of auditory discrimination and/or speech perception capacity.