Conclusions: Our observations support the concept of bilateral cortical activation with monaural and binaural auditory stimulation. The observation that most of the significantly activated areas were the same with monaural or binaural stimulation suggests that the differences in auditory perception with binaural stimulation are not due to the involvement of significantly different processing centers but, more likely, to the type of information that reaches these centers for processing. The observation that the degree of stimulation was less intense in binaural than in monaural stimulation supports the concept that a richer binaural auditory stimulation compared with monaural stimulation does not mean summation of stimuli but integration and better processing of the information. For normal bilateral hearing subjects, a monaural stimulus is an uncommon event and may thus explain the more intense response. The repeatability of the results for monaural and binaural stimulation with pure tones in the same subjects confirms the consistency of the testing method. Objectives: (1) To determine which areas of the cerebral cortex and basal ganglia are activated by binaural stimulation with pure tones (left and right ear simultaneously) and what type of response occurs (e.g. excitatory or inhibitory) in these different areas. (2) To determine the degree of ipsilateral and/or contralateral cortical activation and/or inhibition. (3) To compare the data with our previous reports of monaural stimulation using the same technique and the same subjects. (4) To evaluate the consistency of our testing method. Methods: Brain perfusion single photon emission computed tomography (SPECT) evaluation was conducted using auditory binaural stimulation with pure tones in six normal volunteers. Both ears were stimulated simultaneously. Tc99m HMPAO was injected while pure tones were delivered and the SPECT imaging was done 1 h later. Results: After delivering pure tones there was bilateral activation in Brodmann areas 7 (somatosensory association cortex), 9 and 10 (executive frontal areas), 17, 18, and 19 (associative visual cortex). There was also activation in temporal areas 21, 22 (auditory association areas), and parietal areas 39 and 40 (Wernicke). There was also marked activation in both thalami. These activated areas were the same as those in our previous reports with monaural stimulation in the same subjects. However, except for areas 17, 18, 23, 31, and 32 (which remained over 4 SD above the normal maximum), the degree of activation was less intense in binaural compared with monaural stimulation. Inhibition was also less intense in binaural stimulation. © 2011 Informa Healthcare.