Pediatric audiology: A review of assessment methods for infants

Hearing aid validation based on 40 Hz auditory steady-state response thresholds

BACKGROUND AND AIM

Aided thresholds can be used for prediction of success of hearing aids and to choose between hearing aids and cochlear implants. This study aimed to compare characteristics of aided and unaided auditory steady-state responses (ASSRs).

METHODS

A total of 30 moderate to profoundly hearing-impaired subjects participated in this study. The subjects underwent acoustic immittance, behavioral audiometry, and ASSR with the modulation rate of 40 Hz, first without a hearing aid and then with a hearing aid. Sixteen people with normal hearing and 17 people with severe hearing loss were included in biological calibration of the sound field.

RESULTS

There was a significant difference between unaided behavioral and ASSR thresholds in all test frequencies (mean difference of unaided behavioral ASSR thresholds: 6.19 dB; P = 0.02 at 500 Hz, P < 0.001 at 1000 and 2000 Hz, and P = 0.02 for 4000 Hz). There was also a significant difference between aided behavioral and ASSR thresholds at 1000 and 2000 Hz (P < 0.001) but not at 500 (P = 0.14) and 4000 (P = 0.23) Hz (mean difference of behavioral ASSR thresholds was 4.33 dB). Despite observing any unaided responses, aided thresholds could be recorded in some severe to profoundly hearing-impaired subjects. The number of recordable thresholds was directly related to speech clarity and speech-reading ability. Multi-frequency stimulation elevated the ASSR threshold, especially for the higher frequencies and in the aided condition.

CONCLUSION

Functional and ASSR gains show less difference than threshold data. Therefore, comparing gains instead of thresholds is more accurate for validation of hearing aids. The probability of success of hearing aids appears to be poor if ASSRs (especially aided ones) cannot be recorded. If special care is taken in the fitting of hearing aids and the testing conditions, aided ASSR testing could be a useful tool for validation of hearing aids and the cochlear implant decision-making process.

Longitudinal study of hearing impairment in children

The aim of this study is to evaluate the frequency of progression in permanent childhood hearing impairment (PHI) and to relate potential specific factors to the eventual progression. A description is made of the true longitudinal hearing thresholds in four groups of children according to different observation periods and being part of a prospective pediatric audiological registry-based study established in 1989. At the time of data collection the registry included 1373 children born after 1/1-1970 with a PHI > 20 dB in either the right or the left ear at any pure tone frequency. The children were subdivided according to the following observation periods: 1-3 years (N=266), >3-5 years (N=148), >5-10 years (N=212) and >10 years (N=62). The differences from the first to the most recent audiometric thresholds were analysed for the right and left ears separately, at the pure tone frequencies 250, 500, 1000, 2000, 4000 and 8000 Hz, for the average of 500, 1000, 2000 and 4000 Hz, for the average of 2000 and 4000 Hz and for the average of 4000 and 8000 Hz. Those showing a progression >15 dB for the average across 500-4000 Hz were analysed for age at onset and aetiology of hearing impairment, showing that genetic factors are predominant in progressive PHI. It was also found that progression in PHI is most frequent in early childhood but found only in 5.7% after the age of 4 years.