Comparison between brainstem-evoked response audiometry and behavioral audiometry in 270 infants and children

Evaluation of Hearing Sensitivity in Young Adults With Normal Hearing Using a 40-Hz Auditory Steady-State Response With CE-Chirp

PURPOSE

The present study aimed to measure hearing sensitivity in young adults with normal hearing using a 40-Hz auditory steady-state response with CE-Chirp and to evaluate the speed and accuracy of this method.

METHOD

Twelve young adults (1 man, 11 women; mean age = 22.1 ± 3.1 years) each completed two auditory steady-state response measurement sessions with CE-Chirp. The difference score was calculated at each of the four pure-tone frequencies. The measurement time and residual noise level in all stimulus levels were also determined.

RESULTS

The difference scores across the 4 frequencies ranged within ±10 dB (1st: 58% to 71%, 2nd: 54% to 79%), within 20 dB (1st: 79% to 96%, 2nd: 79% to 100%), and ≥ 30 dB (1st: 4% to 17%, 2nd: 0% to 17%). The measurement times for both ears were approximately 20 min in both sessions. There was a significant correlation between the measurement time and the mean residual noise level for pooled frequencies in all stimulus levels (p = .0001249, r = .70). The measurement time was reduced by approximately 50% from conventional auditory steady-state response measurement.

CONCLUSION

The results of this preliminary study support the use of this technology as a rapid and accurate method for behavioral auditory threshold evaluation.

Screening for neonatal and infant deafness in Europe in 1992

Many methods of screening for hearing impairment are available. The aim of our study was to determine which ones were really used in 1992. At the request of the British Audiology Society, we conducted an inquiry into the organization of screening for deafness in neonates and infants in Europe. In practice all 6-9 month-old infants are tested with behavioural tests in every country. For the neonates, generally only those at risk for hearing-impairment (about 5%) were tested. The most widely used tests were behavioural ones. Only specialized centers used transient evoked otoacoustic emissions (TEOAEs). This last test assesses the active mechanical properties of the cochlea and allows detection of even mild or unilateral sensorineural deafness.

Comparison of the intrasubject repeatability of auditory brain stem and middle latency responses elicited in young children

The auditory brain stem response (ABR) and middle latency response (MLR) were studied in 48 young children (96 ears). The responses were elicited using low intensity stimuli (30-dB nHL clicks) and simultaneously were recorded on a dual time base. Both the ABR and MLR were elicited in 70 ears. In 12 ears, just one response was recorded (ABR in eight ears and the MLR in four ears). In 14 ears, neither response was recorded. Test-retest analysis on the same subject demonstrated that the ABR was more repeatable and easier to identify than the MLR. The test-retest difference was determined for the amplitude and latency of the ABR and MLR waveforms. The test-retest latency difference for wave Pa was found to be 3.6 times larger than for wave V. The normalized test-retest amplitude difference for P phi-Na, Na-Pa, and Pa-Nb was found to be two to three times larger than for wave V. These data support the conclusion that the ABR, rather than the MLR, should be used to measure hearing in young children. The authors also advocate using minimal high pass (HP) filtering when recording the ABR in a sedated or sleeping child. Muscle artifact was not found to be a problem. The authors suggest the use of minimal HP filtering so that phase-shift distortion is minimized and a larger response amplitude can be recorded.

Clinical application of brain-stem audiometry

Based on the examination of 249 consecutive patients, the usefulness of brain-stem response audiometry in a major audiological clinic was evaluated. Auditory brain-stem responses were performed either for hearing threshold determination (67 patients) or for assessment of retrocochlear hearing loss (182 patients). The results demonstrate that ABR is a reliable method for the estimation of hearing thresholds in non-cooperative subjects. The rate of false positives was 5% and no false negatives were found. In combination with caloric testing, ABR is considered a valuable testing procedure in the audiological clinic and it may form the basis for submission to brain imaging examination when a suspicion of retrocochlear hearing disorder is raised. Concerning the diagnosis of retrocochlear hearing disorder, no false negatives have yet been found, while a rate of 13% of false positives has been indicated.

Hearing assessment in developmentally impaired infants: classical conditioning as a supplement to brainstem-evoked response audiometry (BERA)

The brainstem-evoked response audiometry (BERA) is probably the most common approach to hearing assessment in high-risk and developmentally handicapped infants. It is usually suggested, however, that BERA should not be the sole assessment method. In an attempt to determine an effective supplement to BERA, the present study evaluated a classical conditioning procedure with developmentally impaired babies. Within this procedure, different tones served as conditioned stimuli while an air-puff was used as the unconditioned stimulus. Results indicate that this procedure could be successfully applied with almost all of the babies.

Auditory brainstem response (ABR) to tone pips in hearing-impaired children

The correspondence between ABR thresholds to tone pips and behavioral thresholds at 500, 1000 and 2000 Hz was studied in 13 normal and 55 hearing-impaired children, including 42 sensori-neural losses and 13 conductive losses. The children's ages ranged from 1 year 3 months to 8 years. Tone pips were provided with 2-cycle rise-fall times and 2-cycle plateaus. The correlations between the two measures were highly significant at 3 frequencies both in sensori-neural losses and conductive losses. In the subjects with sensori-neural losses, the ABR thresholds tended to be lower than the behavioral thresholds. Mean threshold differences between the ABR and behavioral audiometry at each frequency in sensori-neural losses were 1.6, 0.26 and 5.8 dB, respectively. On the other hand, in the subjects with conductive losses, the ABR thresholds were higher than the behavioral ones by 9.6, 7.8 and 7.5 dB at respective frequencies. Therefore, the hearing acuity in young children with sensori-neural losses can be predicted with accuracy from the ABR thresholds to tone-pips at 500, 1000 and 2000 Hz.

Problems in interpretation of brainstem-evoked response audiometry results

This report describes 6 cases - 3 adults and 3 children - in which no response could be obtained during the brainstem-evoked response audiometry (ABR) examination. This, in spite of the fact that maximal click intensity was used during the test, and despite the patients' nearly normal hearing sensitivity. All of the cases presented a slight degree of neurological deficiency, which could explain the faulty synchronization of the biological response to clicks. Attention is drawn to the fact that lack of response in ABR in cases with central nervous system involvement is not necessarily proof of severe hearing loss, and could supply important diagnostic cues.

An evaluation of the use of the auditory brain-stem electric response test in paediatric audiological assessment

A retrospective study was made of hearing thresholds determined by the click-evoked Brain Stem Electric Response (BSER) and behavioural tests of hearing in 200 babies and children. BSER thresholds were found to agree within 20 dB with high frequency hearing levels in 89 out of 99 children who performed free-field tests of hearing and in 87% of ears in children tested with pure-tone audiometry. In 61 children who were too young or too handicapped to perform on behavioural tests of hearing, a hearing loss was indicated by BSER in 48 out of 121 ears. The majority of these losses occurred in the handicapped group. The advantages and limitations of behavioural tests and BSER are discussed.