多频稳态诱发电位和听性脑干反应对感音神经性聋儿童客观听阈的评估

目的比较多频稳态诱发电位(MASSR)与短纯音听性脑干反应(Tb-ABR)对感音神经性聋儿童客观听阈的评估。方法对37名感音神经性聋儿童分别测试MASSR反应阈、Tb-ABR反应阈和行为听阈,参照行为听阈,比较MASSR反应阈和Tb ABR反应阈对行为听阈评估的准确性。结果MASSR反应阈、Tb-ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时,对行为听阈的评估具有相似的准确性;但在频率为0.5、1kHz时,MASSR的准确性较Tb ABR的准确性高。结论MASSR和Tb-ABR均可用作感音神经性聋儿童言语频率客观听阈的评估,但MASSR在低频(0.5、1kHz)时较Tb-ABR的准确性高。     

Comparison of auditory steady-state response and auditory brainstem response thresholds in children

Recently, auditory steady-state responses (ASSRs) have been proposed as an alternative to the auditory brainstem response (ABR) for threshold estimation. The goal of this study was to investigate the degree to which ASSR thresholds correlate with ABR thresholds for a group of sedated children with a range of hearing losses. Thirty-two children from the University of Iowa Hospitals and Clinics ranging in age from 2 months to 3 years and presenting with a range of ABR thresholds participated. Strong correlations were found between the 2000-Hz ASSR thresholds and click ABR thresholds (r = .96), the average of the 2000- and 4000-Hz ASSR thresholds and click ABR thresholds (r = .97), and the 500-Hz ASSR and 500-Hz toneburst ABR thresholds (r = .86). Additionally, it was possible to measure ASSR thresholds for several children with hearing loss that was great enough to result in no ABR at the limits of the equipment. The results of this study indicate that the ASSR may provide a reasonable alternative to the ABR for estimating audiometric thresholds in very young children.     

Relationship between the auditory brainstem response and auditory nerve thresholds in cats with hearing loss

This study explored the relationship between the auditory brainstem response (ABR) and auditory nerve sensitivity in cats with normal hearing and with noise-induced permanent threshold shifts. A statistically significant linear correlation was found between each cat's ABR thresholds and the most sensitive single neuron thresholds at the same frequency. ABR thresholds were approximately 25 dB higher than the thresholds of the most sensitive neural responses in cats with normal hearing. The two measures produced equivalent thresholds at impaired frequencies in subjects with sensorineural hearing loss. Two factors may have contributed to this convergence of ABR and neural thresholds. First, our results suggest that the elevation of the most sensitive neural responses led to a compressed threshold distribution. Consequently, only a narrow range of sound levels separated stimulus conditions that activated relatively few fibers from those that were sufficient to evoke a robust population response. In addition, the threshold responses of impaired auditory nerve fibers may have been augmented by activity in the more sensitive 'off-frequency' regions that surrounded a discrete cochlear lesion. Across varying degrees of hearing loss, the ABR maintained a systematic relationship to auditory nerve fiber thresholds, and therefore has the potential to be used as a functional assay of cochlear pathology.     

Auditory steady-state response and auditory brainstem response thresholds in children

The inclusion of the auditory steady-state response (ASSR) into test-batteries for objective audiometry has allowed for clinical comparisons with the most widely used procedure, the auditory brainstem response (ABR). The current study describes ASSR and ABR thresholds for a group of infants and young children with various types and degrees of hearing loss. A sample of 48 subjects (23 female) with a mean age of 2.8 ± 1.9 years SD were assessed with a comprehensive test-battery and classified according to type and degree of hearing loss. Thresholds were determined with a broadband click-evoked ABR and single frequency ASSR evoked with continuous tones (0.25–4 kHz) amplitude modulated (67–95 Hz). Mean difference scores (±SD) between the ABR and high frequency ASSR thresholds were 9.8 (±11), 3.6 (±12) and 10.5 (±12) dB at 1, 2 and 4 kHz, respectively. An ASSR mean threshold for 2–4 and 1–4 kHz compared to the ABR threshold revealed an average difference of 7 (±9) and 7.9 (±8) dB, respectively. The overall correlation between the ABR and ASSR thresholds was highest for the mean ASSR thresholds of 2–4 and 1–4 kHz (r = 0.92 for both conditions). Correlations between the ABR and individual ASSR frequencies were slightly less (0.82–0.86). The average of the 2–4 kHz ASSR thresholds correlated best with the click-evoked ABR for all categories of hearing loss except for the sensorineural hearing loss category for which the 1–4 kHz ASSR average was better correlated to ABR thresholds. Findings demonstrate the reliability of verifying high frequency ASSR thresholds with a click-evoked ABR as an important cross-check in infants for whom behavioural audiometry may not be possible.     

多频听觉稳态反应与40Hz听相关电位对儿童客观听阈评估的比较

目的通过对感音神经性聋患儿的多频听觉稳态反应（multiple frequency auditory steady--state response，MFASSR）测试结果进行分析，并比较其在0．5 kHz处与40 Hz听相关电位（40Hz auditory event related potential，40 Hz AERP）对客观听阈评估的准确性，为MFASSR临床应用提供指导。方法对感音神经性聋儿进行纯音测听、ABR、40 Hz AERP和MFASSR测试。MFASSR与ABR、40 Hz AERP测试均在睡眠状态下进行。按照测试结果分为ABR未引出组与ABR引出组。结果①MFASSR在0．5 kHz处引出率比40 Hz AERP低。②0．5 kHz MFASSR反应阈对纯音听阈的评估较1、2、4 kHz MFASSR反应阈对纯音听阈的评估差。③以纯音听阈为标准，在0．5 kHz处MFASSR与40 Hz AERP对纯音听阈的评估差别具有统计学意义（P=0．001），说明，在0．5 kHz处MFASSR对纯音听阈评估的准确性不如40 Hz AERP。结论MFASSR反应阈对0．5 kHz处纯音听阈的预测需要结合40 Hz AERP来判断。     

The prediction of hearing thresholds with auditory steady-state responses for cochlear implanted children

OBJECTIVES: The objectives of this study were to investigate the efficacy of auditory steady-state response (ASSR) in predicting cochlear implanted children's actual behavioural thresholds at various frequencies. METHODS: Twenty-two children with cochlear implants (Nucleus 24 devices) participated in this study. Behavioural thresholds and/or ASSR in cochlear implanted children were obtained to determine the predictive accuracy rates and errors by comparing the estimated range of thresholds with the actual behavioural thresholds. RESULTS: Stable ASSR threshold results were obtained in 22 cochlear implanted children. The predictive accuracy rates were the highest and prediction errors were the smallest at 4000 Hz, among the four tested frequencies, using either the Rance 1995 or the Rance 2002 linear regression formulae. The Rance 2002 regression formulae had a higher predictive accuracy and fewer errors than the Rance 1995 regression formulae in predicting the hearing threshold of cochlear implanted patients at all tested frequencies. CONCLUSIONS: Both behavioural thresholds and ASSR thresholds revealed significant improvements after cochlear implantation. ASSR may be used as a tool in predicting hearing thresholds after cochlear implantation in children. The predictive accuracy is best at 4000 Hz with the Rance 2002 linear regression formulae.     

Multiple auditory steady-state response thresholds to bone-conduction stimuli in young infants with normal hearing

OBJECTIVE: Multiple auditory steady-state responses (ASSRs) probably will be incorporated into the diagnostic test battery for estimating hearing thresholds in young infants in the near future. Limiting this, however, is the fact that there are no published bone-conduction ASSR threshold data for infants with normal or impaired hearing. The objective of this study was to investigate bone-conduction ASSR thresholds in infants from a Neonatal Intensive Care Unit (NICU) and in young infants with normal hearing and to compare these with adult ASSR thresholds. DESIGN: ASSR thresholds to multiple bone-conduction stimuli (carrier frequencies: 500 to 4000 Hz; 77 to 101-Hz modulation rates; amplitude/frequency modulated; single-polarity stimulus) were obtained in two infant groups [N = 29 preterm (32 to 43 wk PCA), tested in NICU; N = 14 postterm (0 to 8 mo), tested in sound booth]. All infants had passed a hearing screening test. ASSR thresholds, amplitudes, and phase delays for preterm and postterm infants were compared with previously collected adult data. RESULTS: Mean (+/-1 SD) ASSR thresholds were 16 (11), 16 (10), 37 (10), and 33 (13) dB HL for the preterm infants and 14 (13), 2 (7), 26 (6), and 22 (8) dB HL for the postterm infants at 500, 1000, 2000, and 4000 Hz, respectively. Both infant groups had significantly better thresholds for 500 and 1000 Hz compared with 2000 and 4000 Hz, in contrast to adults who have similar thresholds across frequency (22, 26, 18, and 18 dB HL). When 500- and 1000-Hz thresholds were pooled, pre- and postterm infants had better low-frequency thresholds than adults. When 2000- and 4000-Hz thresholds were pooled, pre- and postterm infants had poorer thresholds than adults. ASSR amplitudes were significantly larger for low frequencies compared with high frequencies for both infant groups, in contrast to adults, who show little difference across frequency. ASSR phase delays were later for lower frequencies compared with higher frequencies for infants and adults, except for 500 Hz in the preterm group. ASSR phase delays were later for infants compared with adults across frequency. CONCLUSIONS: Infant bone-conduction ASSR thresholds are very different from those of adults. Overall, these results indicate that low-frequency bone-conduction thresholds worsen and high-frequency bone-conduction thresholds improve with maturation. Bone-conduction ASSR threshold differences between the postterm infants and adults probably are due to skull maturation. Differences between preterm and older infants may be explained both by skull changes and a masking effect of high ambient noise levels in the NICU (and possibly to other issues due to prematurity).     

儿童chirp听性脑干反应与行为测听的相关性

目的 采用chirp信号作为声刺激进行听性脑干反应(ABR)测试,观察chirp ABR阈值与行为测听的相关性,探讨chirp ABR作为儿童临床客观听力评估的可行性.方法 选择2007年8月至9月佛山市听觉语言康复中心的听力障碍儿童和广州市儿童医院听力门诊的正常听力儿童共22例(共35耳)作为研究对象,分别进行行为测听和chirp ABR测试,并对chirp ABR反应阈和行为测听阈值进行Pearson相关性分析.结果 22例接受测试儿童中男14例,女8例,年龄3.3～6.5岁,平均年龄4.8岁.纳入研究的35耳中,正常听力6耳,听力损失轻度2耳、中度4耳、重度10耳、极重度13耳.行为测听0.5、1、2、4 kHz平均听阈与chirp ABR阈值,0.5 kHz听阈与L-chirp ABR阈值,1～4kHz平均听阈与U-chirp ABR阈值之间的相关系数分别为0.939,0.900及0.930,P值均<0.05.结论 chirp ABR作为一种客观测听技术,能够较好地反映儿童的听力水平,有希望应用到临床工作中.     

Estimation of hearing loss in children: comparison of auditory steady-state response, auditory brainstem response, and behavioral test methods

The current pediatric test battery is limited in the severe-to-profound hearing loss range by the inability to obtain frequency-specific thresholds. Auditory steady-state response (ASSR) is an evoked potential test that can accurately measure auditory sensitivity beyond the limits of other test methods. The limited amount of clinical research, however, has delayed the acceptance of ASSR into the standard pediatric test battery. This study compared thresholds from 76 children using ASSR, ABR, and behavioral test methods. Resulting correlations were strong and supported the inclusion of ASSR into the standard pediatric test battery. ASSR testing provides audiometric information that is essential in the management of children with severe-to-profound hearing loss.     

感音神经性聋儿多频稳态诱发电位及短纯音听性脑干反应与行为测听的相关性

目的 比较多频稳态诱发电位（MASSR）、短纯音听性脑干反应（Tb—ABR）与感音神经性聋儿行为测试听阈的差值．研究MASSR和Tb—ABR反应阈与行为听阈之间是否存在相关性以及在不同听力损失聋儿、不同的频率之间的差异。方法 对60名感音神经性聋儿分别测试MASSR和Tb—ABR反应阈和行为听阈，评价MASSR反应阈、Tb—ABR反应阈与行为听阈的相关性。结果 MASSR反应阈、Tb—ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时，对行为听阈的预测具有相似的、较高的准确性；但在频率为0．5、1kHz时，MASSR的准确性较Tb—ABR高。结论 MASSR和Tb—ABR均可用作感音神经性聋儿言语频率客观听阈的预测，为低龄儿童及难以检测行为听力的患儿提供诊断依据。     

正常新生儿和婴儿的短音听性脑干反应和听觉稳态反应

目的 建立听力正常婴儿短音听性脑干反应(tone-pip ABR)和听觉稳态反应(auditorysteady state response,ASSR)反应阈的正常参考值,研究其听觉发育的生物学规律,并比较两种听力检测技术的频率特性.方法 选取0～6月龄听力正常婴儿80例(160耳),按月龄分为四组:新生儿组、42 d组、3月龄组和6月龄组,每组20例(40耳),男女例数均等,分别记录其短声ABR的潜伏期及在0.25、0.5、1、2、4、8 kHz频率范围内tone-pip ABR和ASSR的反应阈.结果 在70 dB正常听力级短声刺激下,短声ABRⅠ、Ⅲ、Ⅴ波潜伏期、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期随月龄增加逐渐缩短,波Ⅰ于42 d前、波Ⅲ于3个月前发育变化显著.tone-pip ABR波形与短声ABR相似,Ⅰ、Ⅲ、Ⅴ波潜伏期随频率增加逐渐缩短,波形分化逐渐清晰.不同频率、不同月龄tone-pip ABR和ASSR反应阈差异具有统计学意义(P值均＜0.05).除0.25 kHz外,其余频率tone-pip ABR反应阈均低于ASSR.不同月龄tone-pip ABR和ASSR听力曲线形状相似.结论 0～6月正常婴儿tone-pip ABR的潜伏期和波间期随月龄增加逐渐缩短,而反应阈无明显变化.tone-pip ABR和ASSR均有稳定的频率特异性,tone-pip ABR反应阈低于ASSR,可能更接近主观纯音听阈.     

重度极重度聋儿童不同刺激声ASSR与行为测听听阈的一致性及相关性分析

目的通过对比传统ASSR和NB-Chirp刺激声ASSR诱发阈同行为测听听阈的相关性,评价重度-极重度聋儿童中,不同刺激声ASSR在客观听阈评估中的价值。方法对重度-极重度聋儿童进行传统ASSR和NB-Chirp-ASSR检查(每组各30人60耳),两组儿童均进行行为测听检查,将ASSR的诱发阈和行为测听的听阈进行比较,分析NB-Chirp刺激声ASSR和传统ASSR同行为测听听阈一致性,对比两种不同刺激声ASSR同行为测听听阈的相关性。结果 NB-Chirp刺激声ASSR组和传统ASSR组的诱发阈同行为测听听阈的一致性均较好,前者91.67%,后者83.33%。传统ASSR组500Hz诱发阈、NB-Chirp ASSR 1000Hz、2000Hz及4000Hz诱发阈均与行为测听听阈存在中度相关,相关系数分别为0.62、0.53、0.56和0.51。其余频率呈低度相关。结论对于重度-极重度聋儿童,同传统ASSR相比,NB-Chirp ASSR能更好的反映纯音听阈。     

Effects of ambient acoustic noise on the auditory steady-state response thresholds in normally hearing adults

The effect of noise on auditory steady-state response (ASSR) has not been systematically studied, despite the fact that ASSR thresholds are sometimes measured in noisy environments. This study examined the effects of noise (speech babble) on the ASSR thresholds obtained from 31 normal hearing adults aged from 17 to 36 years (mean = 25 years). The ASSR thresholds at 0.5, 1, 2 and 4 kHz were measured in the right ear only using the Biologic MASTER system twice in quiet and in the presence of 55 dB A and 75 dB A of speech babble. The results showed no change in mean ASSR thresholds across the test-retest conditions in quiet. The mean ASSR thresholds obtained in the quiet conditions were 23.8, 22.5, 18.2 and 20.4 dB HL at 0.5, 1, 2 and 4 kHz, respectively. No significant shift in ASSR thresholds across all test frequencies was found when 55 dB A of speech babble was presented. However, when 75 dB A of noise was applied, the mean ASSR thresholds were significantly shifted by 9.5, 3.8, 4.2 and 5.8 dB at 0.5, 1, 2 and 4 kHz, respectively.     

听性稳态反应与听性脑干反应阈值的比较

目的:通过比较同一组聋儿听性脑干反应(ABR)和听性稳态反应(ASSR)的反应阈值,对ASSR的临床应用价值作出评价。方法:分别记录65例年龄在2.5个月~5.5岁聋儿的ABR及ASSR结果并进行比较及相关分析。结果:本组聋儿ABR反应阈值左右耳分别为(85.82±12.39)和(82.70±14.93)dB nHL;ASSR 4个测试频率的反应阈值左耳为(86.91±16.70)(、90.32±16.11)、(91.02±16.58)、(89.80±17.08)dB HL,右耳为(85.15±18.16)(、89.32±17.76)(、90.41±18.87)(、85.15±17.03)dB HL。ASSR 4个测试频率的反应阈值与ABR结果的相关系数分别为左耳0.622、0.721、0.757、0.714和右耳0.613、0.732、0.795、0.739。结论:ASSR与ABR测试结果有显著的相关性,而ASSR所获得的是分频资料,因此这种测试方法有较高的临床应用价值。     

Auditory steady-state response thresholds of adults with sensorineural hearing impairments

This study evaluated the use of multiple auditory steady-state responses (ASSRs) to estimate the degree and configuration of behavioral audiograms of subjects with sensorineural hearing impairments. Place specificity of the multiple-ASSR method was also assessed. Multiple amplitude-modulated (77-105 Hz) tones (500, 1000, 2000 and 4000 Hz) were simultaneously presented to one ear. The results showed that, on average, multiple-ASSR thresholds were 14 +/- 13, 8 +/- 9, 10 +/- 10 and 3 +/- 10 dB above behavioral thresholds for 500, 1000, 2000 and 4000 Hz, respectively. Behavioral and multiple-ASSR thresholds were significantly correlated (r = 0.75-0.89). There were no significant differences between behavioral and multiple-ASSR measures of the audiogram configuration. In subjects with steep-sloping > or = 30 dB/ octave) hearing losses, multiple-ASSR thresholds did not underestimate behavioral thresholds revealing good place specificity. These results indicate that the multiple-ASSR method provides good estimates of the degree and configuration of hearing in individuals with sensorineural hearing impairments.     

Air-bone gap estimated with multiple auditory steady-state response in young children with otitis media with effusion

Objective

Multiple auditory steady-state responses (ASSRs) to air- and bone-conduction stimuli were recorded in young children with otitis media with effusion (OME). After treatment for OME, differences between pre-treatment bone-conduction ASSR levels and post-treatment conditioned orientation reflex (COR) or air-conduction ASSR levels were examined, and compared with ASSR-estimated air-bone gap (ABG) before treatment.

Methods

Navigator Pro with Master was used to assess the threshold of air- and bone-conduction ASSR in both ears at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. For bone-conduction ASSR, RadioEar B-71 bone-vibrator placed on the mastoid was used with white-noise masking on the contralateral ear.

Results

After ventilation tube placement, the thresholds of COR got closer to those of pre-treatment bone-conduction ASSR in young children with OME. Moreover, post-treatment air-conduction ASSR thresholds also got closer to those of pre-treatment bone-conduction ASSR. The differences between pre-treatment bone-conduction ASSR thresholds and post-treatment COR or air-conduction ASSR thresholds became much smaller than ASSR-estimated ABG before treatment.

Conclusion

These findings suggest that bone-conduction ASSR can assess the normal or near normal cochlear sensitivity in young children with conductive hearing loss. It is also suggested that ASSR-estimated ABG can be used clinically to predict their accurate ABG.     

Auditory brainstem response results as predictors of behavioral auditory thresholds in severe and profound hearing impairment

Pediatric cochlear implantation is restricted to patients with stable, bilateral profound sensorineural hearing losses who derive no benefit from conventional amplification. Obtaining reliable audiologic thresholds in a young child with sudden or early-onset hearing loss can be challenging. This study examines the accuracy with which auditory brainstem response evaluation can predict unaided and aided behavioral thresholds in a child with severe-to-profound hearing loss. Reliable behavioral thresholds were obtained on 119 children who had no measurable click-evoked auditory brainstem responses at instrumentation limits of 100 dB HLn. These data show that an absent auditory brainstem response at 100 dB HLn does not necessarily indicate the absence of measurable unaided hearing for test frequencies ranging from 250 Hz to 4000 Hz. Average aided thresholds of better than 60 dB were present in 43% of the children for 500, 1000, and 2000 Hz and in 53% for 500 and 1000 Hz. Therefore, the absence of a click-evoked auditory brainstem response at 100 dB HLn in a young child is not prima facie evidence of the child's cochlear implant candidacy.     

Threshold prediction in children with sensorioneural hearing loss using the auditory steady-state responses and tone-evoked auditory brain stem response

Objective

The purpose of this study was to compare ASSRs to tone-evoked ABR and to behavioral thresholds obtained on follow-up audiometry at 500, 1000, 2000, and 4000 Hz in infants and young children.

Methods

The study included 17 infants and young children ages between 2 months and 3 years old, with sensorineural hearing loss. The ASSRs thresholds were compared with the tone-evoked ABR thresholds, and with the behavioral thresholds obtained on follow-up audiometry.

Results

The correlation of tone-evoked ABR and ASSRs thresholds at 500, 1000, 2000 and 4000 Hz was 0.91, 0.76, 0.81, 0.89, respectively. ASSRs and behavioral hearing thresholds obtained on follow-up were highly correlated, with Pearson r values exceeding 0.94 at each of the test frequencies.

Conclusions

Multiple ASSRs have strong correlations to tone-evoked ABR and to behavioral thresholds obtained during follow-up in hearing impaired infants and young children. These results might be useful in order to provide further evidence for the use of multiple ASSRs, as an alternative tool to tone-evoked ABR, although further data are still required.     

Objective assessment of auditory thresholds in noise-induced hearing loss using steady-state evoked potentials

The purpose of this study is to evaluate whether steady-state evoked potential (SSEP) can be used for objective estimation of auditory thresholds in patients with noise-induced hearing loss (NIHL). Eleven subjects (22 ears) with a characteristic audiometric notch between 3000 and 6000 Hz participated in this study. Both pure-tone thresholds and SSEP thresholds were obtained for each ear of all subjects. The correlation of SSEP thresholds and pure-tone thresholds was assessed. The results show that SSEP thresholds predicted pure-tone thresholds with correlation coefficients (r) of 0.86, 0.92, 0.94 and 0.95 at 500, 1000, 2000 and 4000 Hz respectively. Typically, the SSEP thresholds overestimate the pure-tone thresholds by 10-20 dB, but they closely reflect the configuration of the audiogram. The strength of the relationship between SSEP and pure-tone thresholds increased with increasing frequency and increasing degree of hearing loss. In conclusion, SSEP can be used as a reliable and objective tool to assess auditory thresholds in patients with noise-induced hearing loss with high-frequency dips.