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Purpose: Clinical use of electrophysiologic measures has been limited to use of brief stimuli to evoke responses. While brief stimuli elicit onset responses in individuals with normal hearing and normal central auditory nervous system (CANS) function, responses represent the integrity of a fraction of the mainly excitatory central auditory neurons. Longer stimuli could provide information regarding excitatory and inhibitory CANS function. Our goal was to measure the onset–offset N1–P2 auditory evoked response in subjects with normal hearing and subjects with moderate high-frequency sensorineural hearing loss (HFSNHL) to determine whether the response can be measured in individuals with moderate HFSNHL and, if so, whether waveform components differ between participant groups.Method: Waveforms were obtained from 10 participants with normal hearing and seven participants with HFSNHL aged 40–67 years using 2,000-ms broadband noise stimuli with 40-ms rise–fall times presented at 50 dB SL referenced to stimulus threshold. Amplitudes and latencies were analyzed via repeated-measures analysis of variance (ANOVA). N1 and P2 onset latencies were compared to offset counterparts via repeated-measures ANOVA after subtracting 2,000 ms from the offset latencies to account for stimulus duration. Offset-to-onset trough-to-peak amplitude ratios between groups were compared using a one-way ANOVA.Results: Responses were evoked from all participants. There were no differences between participant groups for the waveform components measured. Response × Participant Group interactions were not significant. Offset N1–P2 latencies were significantly shorter than onset counterparts after adjusting for stimulus duration (normal hearing: 43 ms shorter; HFSNHL: 47 ms shorter).Conclusions: Onset–offset N1–P2 responses were resistant to moderate HFSNHL. It is likely that the onset was elicited by the presentation of a sound in silence and the offset by the change in stimulus envelope from plateau to fall, suggesting an excitatory onset response and an inhibitory-influenced offset response. Results indicated this protocol can be used to investigate CANS function in individuals with moderate HFSNHL.Supplemental Material S1. Poster presentation from Gonzalez and Musiek, 2012, showing offset latencies occurred about 40 ms earlier than expected given onset latencies. Gonzalez, J. E., & Musiek, F. E. (2021). The onset–offset N1–P2 auditory evoked response in individuals with high-frequency sensorineural hearing loss: Responses to broadband noise. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2021_AJA-20-00113

The opinion article “An Evidence-based Perspective on Misconceptions Regarding Pediatric Auditory Processing Disorder” by Neijenhuis et al. (1) presents a distorted view of the evidence-based approach used in medicine. The authors focus on the amorphous non-diagnostic entity “listening difficulties” not auditory processing disorder (APD) and create confusion that could jeopardize clinical services to individuals with APD. In our perspective article, we rebut Neijenhuis et al. (1), and more importantly, we present a rationale for evidence-based practice founded on the premise that research on APD is only clinically applicable when conducted on clinical populations diagnosed with APD. Open-Access-Publikationsfonds 2019 peerReviewed