Test accuracy and prognostic validity of multiple auditory steady state responses for targeted hearing screening

The test accuracy and prognostic validity of Multiple Auditory Steady State Responses (MSSR) and click Auditory Brainstem Responses (cABR) was compared within the context of a targeted screening protocol. A sample of 508 high-risk babies was first screened using cABR and MSSR (500 and 2000 Hz). All children (failed/ pass) were called back at three to four years of age to determine their hearing status (pure-tone audiometry). Although both methods showed an equally good test performance in the first screen (sensitivity: 100% and specificity: 92-95%), the MSSR may have some potential advantage to identify low-frequency hearing loss. Furthermore, the confirmatory audiometry with MSSR predicted the child hearing status more accurately than the cABR. In conclusion, the MSSR can provide valuable information for the diagnosis and management of infants earlier detected by a screening protocol and further developed might be also useful as a screening test.     

多频听觉稳态反应评估听力正常青年人骨导听阈的研究

目的 探讨多频听性稳态反应（MASSR）评估听力正常青年人骨导纯音听阈的可能性,旨在观察听力正常青年人骨导多频听觉稳态反应（ASSR）测试的正常值特点,进一步探讨骨导ASSR的反应阈与骨导纯音听阈的相关性,为临床上对不能配合做纯音测听的患者行听力评估时提供客观参考。方法 对20例（男10例、女10例）听力正常青年人进行骨导ASSR 及骨导纯音听阈检查,记录0.5、1.0、2.0、4.0kHz反应阈及行为听阈,比较二者间的相关性。结果 骨导ASSR 反应阈男组、女组间差异无统计学意义;各频率间骨导ASSR 反应阈比较,4.0kHz较其它各频率差异有统计学意义（P＜0.001）,0.5、1.0、2.0kHz三个频率间差异无统计学意义（P＞0.05）。骨导ASSR 反应阈与骨导纯音听阈在0.5、1.0、2.0、4.0kHz四个频率处相关系数分别为0.95、0.91、0.26、0.29。结论 骨导ASSR反应阈与骨导纯音听阈间只有在0.5、1.0kHz时有较好的相关性,高频的骨导ASSR与骨导纯音听阈差异性比较大,因此目前还不能广泛用于临床评估高频骨导纯音听阈。     

Prognostic validity of dichotic multiple frequencies auditory steady-state responses versus distortion product otoacoustic emissions in hearing screening of high risk neonates

Objective

To determine the validity of dichotic multiple frequencies auditory steady-state responses (ASSR) as a hearing screening technique versus using distortion product otoacoustic emissions (DPOAEs) among high-risk neonates.

Methods

A cross sectional study was performed on 118 high-risk neonates by means of dichotic multiple frequencies ASSR and DPOAE for hearing screening. DPOAE results were used as the standard for hearing screening in parallel with ASSR. Dichotic multiple frequencies ASSR results were analyzed by means of F-value of less or greater than 0.05 criteria as a pass-fail for the responses. Dichotic multiple ASSR hearing screening technique was considered in two intensity levels at 40 and 70 dB HL. The ASSRs thresholds were measured in high risk neonates with and without hearing deficits as determined by DPOAES. The results of ASSR and DPOAE were compared to be gathered by contingency table in order to obtain sensitivity, specificity and other different statistical values. Average performing times for the tests were analyzed.

Results

The specificity of dichotic multiple ASSR was 92.6%, 93.8% and the sensitivity was 71.6%, 62.2% at the 70 and 40 dB hearing levels, respectively. Mean ASSR thresholds for normal-hearing infants at an average corrected age of 6 days were 32.2 ± 12.2, 29.8 ± 10.2, 26.2 ± 11.4 and 30.4 ± 10.8 dB HL for 0.5, 1, 2 and 4 kHz, respectively. The average times for performing the tests were 18.7 and 32.9 min respectively.

Conclusions

ASSR with this special paradigm is a fairly desirable method for hearing screening of high-risk neonates. There is good concordance between ASSRs and DOPAEs results among high risk neonates referred for hearing screening. The sensitivity and specificity of this test is sufficient for hearing screening in high risk neonates. This test could be valuable for rapid confirmation of normal thresholds. As long as further research have not been conducted on ASSR, great caution should be made to interpret the results of ASSR as a hearing screening technique in young infants and also additional techniques such as the tone-evoked ABRs should be used to cross-check results. It's still too soon to recommend ASSRs as a standalone electrophysiologic measure of hearing thresholds in infants.     

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。     

Evaluation of auditory brainstem responses for hearing screening of high-risk infants

Auditory brainstem responses (ABR) were recorded in 30 normal and 60 high-risk neonates with gestational age between 30 and 45 weeks. The normative data of normal group as regard to age, sex and various parameters of ABR were compared with high-risk group. ABR parameters especially wave V and interwave V-I intervals were significantly prolonged in high-risk infants. An infant was considered to “pass” the ABR test if an identifiable and replicable wave V response was present at 30 dB HL in both ears. All the normal neonates had click thresholds consistent with normal hearing. 12 of the highrisk neonates showed mild to moderate hearing impairment (absent replicable wave V at 30–60 dB HL) and 2 of them showed severe to profound hearing impairment (absent replicable wave V at 70 dB HL). 9 of the “failed” group were reevaluated within 3 months and several times thereafter if the abnormal responses persisted. 2 (3.3%) infants showed persistent hearing loss, which was confirmed later by behavioral audiometry.     

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。     

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。     

Comparison of hearing threshold determined by auditory pathway electric responses and by behavioural responses

In order to evaluate their reliability for determining the hearing threshold, the cochlear microphonic potentials, the auditory nerve and brain stem neural evoked responses as well as the cortical evoked responses were compared with the behavioural hearing thresholds of the same subjects in the same session. The threshold for recording the cochlear microphonic potential was found to be appreciably higher than the behavioural threshold. The threshold for recording the auditory nerve and brain stem responses was within a few decibels of the behavioural threshold. The threshold of the cortical evoked response was several decibels higher. It is concluded that (1) the auditory nerve and brain stem neural evoked responses are the best indicators of hearing threshold; (2) the cortical evoked responses are usually comparable, and (3) all types of evoked responses are indispensable aids in the evaluation of hearing and the determination of site of lesion in the auditory system.     

Desynchronisation of auditory steady-state responses related to changes in interaural phase differences: an objective measure of binaural hearing

Objective: Binaural processing can be measured objectively as a desynchronisation of phase-locked neural activity to changes in interaural phase differences (IPDs). This was reported in a magnetoencephalography study for 40?Hz amplitude modulated tones. The goal of this study was to measure this desynchronisation using electroencephalography and explore the outcomes for different modulation frequencies. Design: Auditory steady-state responses (ASSRs) were recorded to pure tones, amplitude modulated at 20, 40 or 80?Hz. IPDs switched between 0 and 180° at fixed time intervals. Study sample: Sixteen young listeners with bilateral normal hearing thresholds (≤25?dB HL at 125–8000?Hz) participated in this study. Results: Significant ASSR phase desynchronisations to IPD changes were detected in 14 out of 16 participants for 40?Hz and in 8, respectively 9, out of 13 participants for 20 and 80?Hz modulators. Desynchronisation and restoration of ASSR phase took place significantly faster for 80?Hz than for 40 and 20?Hz. Conclusions: ASSR desynchronisation to IPD changes was successfully recorded using electroencephalography. It was feasible for 20, 40 and 80?Hz modulators and could be an objective tool to assess processing of changes in binaural information.     

Sedation for children 2 to 5 years of age undergoing auditory brainstem response and auditory steady state responses recordings

Abstract

Objective: To evaluate the feasibility, the duration and results of sedation by intrarectal pentobarbital and oral alimemazine for auditory brain stem responses (ABR) and auditory steady-state responses (ASSR) recordings in children aged 2 to 5 years. Design: Prospective study. Study sample: 180 consecutive children aged 2 to 5 years, referred for language retardation and/or behavioral problems, who could not be tested by behavioral methods, underwent ABR and ASSR recordings. The children who did not spontaneously nap were sedated by intrarectal pentobarbital eventually potentiated by oral alimemazine. Results: A spontaneous nap was obtained in only 23 cases, 72 children received only pentobarbital, and 85 received both pentobarbital and alimemazine. Even so, recording was impossible in 16 cases, and interrupted before completion of the ASSR recordings in 45 cases. Children went to sleep in average 64 min +/? 40. The average recording time for the ABR was 20 minutes, and for the ASSR 25 minutes. Conclusion: Sedation by pentobarbital, eventually completed by oral alimemazine, allows ABR and/or ASSR recordings in 89.8% of the children who did not nap in the recording room, and is therefore a good alternative to general anesthesia in these children.     

听力筛查转诊婴幼儿不同滤波条件短纯音诱发听性脑干反应的比较

目的 短纯音诱发听性脑干反应(ABR)是听力筛查转诊婴幼儿听力评估的重要方法,本研究比较滤波分别为30～1500 Hz与30～3000 Hz时不同频率短纯音ABR阈值之间的差异,总结两种滤波条件下ABR波形特点及对阈值判断的影响,以选择更优化的频率特异性ABR测试参数.方法 应用美国IHS公司SmartEP听觉诱发电位仪记录18例(22耳)2～33月龄婴幼儿短声、滤波为30～1500 Hz与30～3000 Hz短纯音ABR各频率反应阈.结果 0.5 kHz、1 kHz、2 kHz、4 kHz滤波为30～3000 Hz短纯音ABR反应阈比滤波为30～1500 Hz短纯音ABR反应阈高.0.5 kHz及2.0 kHz两种滤波条件下短纯音ABR反应阈之间差异具有统计学意义(t值分别为2.238及2.217,P值均＜0.05),其他频率两种滤波条件下反应阈之间差异无统计学意义(P值均＞0.05).同等刺激强度下,滤波为30～3000 Hz的ABR波形与30～1500 Hz相比不平滑,反应波曲线上会出现锯齿状细小的干扰波.结论 在用短纯音ABR反应阈评估婴幼儿听力时,30～1500 Hz可以作为更优化的滤波设置参数.

Abstract：

Objective Auditory brainstem responses (ABR) evoked by tone burst is an important method of hearing assessment in referral infants after hearing screening. The present study was to compare the thresholds of tone burst ABR with filter settings of 30 - 1500 Hz and 30 - 3000 Hz at each frequency,figure out the characteristics of ABR thresholds with the two filter settings and the effect of the waveform judgement, so as to select a more optimal frequency specific ABR test parameter. Methods Thresholds with filter settings of 30 - 1500 Hz and 30 -3000 Hz in children aged 2 -33 months were recorded by click,tone burst ABR. A total of 18 patients ( 8 male / 10 female), 22 ears were included. Results The thresholds of tone burst ABR with filter settings of 30 - 3000 Hz were higher than that with filter settings of 30 - 1500 Hz. Significant difference was detected for that at 0. 5 kHz and 2.0 kHz ( t values were 2.238 and 2. 217, P ＜ 0. 05 ), no significant difference between the two filter settings was detected at the rest frequencies tone evoked ABR thresholds. The waveform of ABR with filter settings of 30 - 1500 Hz was smoother than that with filter settings of 30 - 3000 Hz at the same stimulus intensity. Response curve of the latter appeared jagged small interfering wave. Conclusions The filter setting of 30 - 1500 Hz may be a more optimal parameter of frequency specific ABR to improve the accuracy of frequency specificity ABR for infants' hearing assessment.     

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

OBJECTIVE: Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS: From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS: The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS: Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.     

Comparison of multiple auditory steady-state responses (80 versus 40 Hz) and slow cortical potentials for threshold estimation in hearing-impaired adults

This study evaluated the use of multiple auditory steady-state responses (ASSRs) and slow cortical potentials (SCPs) to estimate behavioural audiograms in adults for compensation cases. Two groups of 23 subjects were assessed using either 80 Hz or 40 Hz multiple simultaneous tones with carrier frequencies of 0.5, 1.0, 2.0, and 4.0 kHz. SCP thresholds for 0.5, 1.0, and 2.0 kHz were obtained for both groups. Mean evoked potential thresholds (dB HL) minus behavioural pure-tone thresholds (dB HL) difference scores were 5–17 dB for the 80 Hz group, 1–14 dB for the 40 Hz group, and 20–22 dB for the SCPs. Thresholds for 40 Hz ASSR were significantly closer to behavioural thresholds than were 80 Hz or SCP thresholds. SCP and 40 Hz ASSR audiogram estimates were obtained more quickly than the 80 Hz ASSR. Multiple 40 Hz ASSR is the method of choice for evoked potential threshold estimation in adults.

Sumario

Este estudio evaluó el uso de las respuestas auditivas múltiples de estado estable (ASSR) y de los potenciales corticales lentos (SCP) para estimar en casos de compensación, los audiogramas comportamentales de adultos. Se realizaron pruebas en dos grupos de 23 sujetos utilizando tonos múltiples simultáneos a 80 ó 40 Hz con frecuencias portadoras de 500, 1000, 2000 y 4000 Hz. Se obtuvieron umbrales SCP para 500, 1000 y 2000 Hz en ambos grupos. Los umbrales promedio de potenciales evocados (dBHL) menos las respuestas tonales comportamentales se ubicaron entre 5 y 17dB para el grupo de 80 Hz, de 1 a 40 dB para el grupo de 40 Hz y de 20 a 22 dB para los SCP. Los umbrales de las ASSR de 40 Hz estuvieron significativamente mas cercanos a los umbrales comportamentales que los de 80 Hz o los umbrales SCP. Los SCP y las ASSR-40 Hz se obtuvieron más rápido que las ASSR-80 Hz. Las ASSR múltiples de 40 Hz son el método de elección para la estimación de umbrales con potenciales evocados en adultos.     

The comparison of auditory behavioral and evoked potential responses (steady state and cortical) in subjects with occupational noise-induced hearing loss

ObjectiveTo define difference scores between PTA, ASSR and CERA thresholds in subjects with occupational NIHL.Design44 subjects undergoing a medico-legal expert assessment for occupational NIHL and fulfilling criteria of reliability were considered. Assessment included: PTA, 40 Hz binaural multiple ASSR and CERA (1-2-3 kHz).ResultsThe respective average difference scores (ASSR - PTA) for 1, 2 and 3 kHz are 13.01 (SD 10.19) dB, 12.72 (SD 8.81) dB and 10.38 (SD 8.19) dB. The average (CERA - ASSR) difference scores are 1.25 (SD 14.63) dB for 1 kHz (NS), 2.73 (SD 13.03) dB for 2 kHz (NS) and 4.51 (SD 12.18) dB for 3 kHz. The correlation between PTA and ASSR (0.82) is significantly stronger than that between PTA and CERA (0.71). In a given subject, PTA thresholds are nearly always lower (i.e., better) than ASSR thresholds, whatever the frequency (1-2-3 kHz) and the side (right – left). A significant negative correlation is found between the difference score (ASSR – PTA) and the degree of hearing loss.ConclusionASSR outperforms CERA in a medicolegal context, although overestimating the behavioral thresholds by 10–13 dB_.     

The accuracy of objective threshold determination at low frequencies: comparison of different auditory brainstem response (ABR) and auditory steady state response (ASSR) methods

Objective: The hearing threshold at 500?Hz was estimated using five methods which are suitable for the low frequency range: Low-Chirp BERA (LCBERA), Notched-noise BERA (NNBERA), Narrow band CE-Chirp BERA (NBCBERA) and Narrow band CE-Chirp ASSR (NBCASSR) (40/90?Hz). The slope of the discrimination function of each method was used for determination of the most efficient method. The threshold values were compared and the corresponding odds ratios (OR) were calculated. Design: All methods were applied to each subject. Stimulus levels were arranged individually. Response detection was carried out by visual inspection of the records in case of BERA and automatically in case of ASSR. Each individual series of recordings was converted to a dichotomous function indicating whether or not a response was discernible and a continuous method-specific discrimination function was constructed. This function was realised by a Boltzmann function whose slope in the inflection point serves as quality measure. Additionally, an OR evaluation was carried out in order to validate the significance of results. Study sample: Twenty five normal hearing adults (aged 18–30 years) were tested. Results: LCBERA proved to have the highest reliability according to the slope of the Boltzmann function, the comparison of threshold values and OR. Conclusions: The LCBERA is recommended for use in routine clinical practice.     

听觉脑干反应相位谱分析客观诊断中高频听力损失

采用Fridman提出的相位谱分析方法——同步度（SM）测试法，对40dBnHL短声诱发的正常耳听觉脑干反应（ABR）进行相位谱构型分析。40耳统计表明，ABR相位谱主要包含4个频域成分，即A：0～160Hz、B：160～440Hz、C：440～930Hz和D：930～1370Hz，以各成分谱参量——SM的平均值和标准差的差值作为鉴别中高频听力损失的标准值。对测试组各聋耳（49耳）40dBnHL短声诱发ABR进行相位谱构型分析，计算上述各主要相位谱成分的SM值，并同相应成分的标准值进行比较，以判定中高频性耳聋。各谱成分对测试耳的正确诊断丰分别为A：59．2％、B：51．0％、C：95．9％和D：44．9％。结果表明，C成分是ABR相位谱的唯一特征成分，其SM值能有效确定中高频听力损失，可作为客观诊断中高频性耳聋的临床指标。