不同程度感音神经性听力损失儿童ASSR、click-ABR反应阈与行为听阈的相关性

目的 探讨不同程度感音神经性听力损失儿童听性稳态反应(ASSR)、短声听性脑干反应(click-ABR)与行为阈值的相关性及在听障儿童听力评估中的价值.方法 回顾性分析2019年1月至2019年12月确诊的46例(92耳)感音神经性听力损失儿童的ASSR、click-ABR及行为听阈结果,其中,轻度听力损失4耳,中度听...     

Auditory steady-state responses for estimating moderate hearing loss

The auditory steady-state response (ASSR) has gained popularity as an alternative technique for objective audiometry but its use in less severe degrees of hearing loss has been questioned. The aim of this study was to investigate the usefulness of the ASSR in estimating moderate degrees of hearing loss. Seven subjects (12 ears) with moderate sensorineural hearing loss between 15 and 18 years of age were enrolled in the study. Forty-eight behavioural and ASSR thresholds were obtained across the frequencies of 0.5, 1, 2, and 4 kHz. ASSR thresholds were determined using a dichotic multiple frequency recording technique. Mean threshold differences varied between 2 and 8 dB (±7–10 dB SD) across frequencies. The highest difference and variability was recorded at 0.5 kHz. The frequencies 1–4 kHz also revealed significantly better correlations (0.74–0.88) compared to 0.5 kHz (0.31). Comparing correlation coefficients for behavioural thresholds less than 60 and 60 dB and higher revealed a significant difference. Eighty-six percent of ASSR thresholds corresponded within 5 dB of moderate to severe behavioural thresholds compared to only 29% for mild to moderate thresholds in this study. The results confirm that the ASSR can reliably estimate behavioural thresholds of 60 dB and higher, but due to increased variability, caution is recommended when estimating behavioural thresholds of less than 60 dB, especially at 0.5 kHz.     

Threshold estimation in children using auditory steady-state responses to multiple simultaneous stimuli

OBJECTIVE: It was the aim of this study to explore the use of auditory steady-state response (ASSR) to multiple simultaneous stimuli for threshold estimation in young children. METHOD: The subjects consisted of 40 children, aged from 6 months to 5 years, with variant degrees of sensorineural hearing loss. Simultaneous tonepips (0.5, 1, 2 and 4 kHz) with an amplitude modulated at different rates from 77 to 103 Hz were presented to both ears by insert phones. All children were tested with ASSR and age-appropriate behavioral tests. RESULTS: We found that (1) ASSR thresholds were usually higher than behavioral thresholds with a difference of 8-15 dB, (2) the behavioral thresholds were significantly correlated with ASSR thresholds (p = 0.000), and (3) there was a great difference between ASSR thresholds and behavioral thresholds found in a child with auditory neuropathy. CONCLUSION: Being objective, frequency specific and well correlated with behavioral thresholds, ASSR to multiple simultaneous stimuli was proven to be a good tool to predict behavioral hearing thresholds.     

多频稳态诱发电位评估中度感音神经性聋儿童的应用

目的探讨多频稳态听觉诱发电位评估儿童中度感音神经性聋的可靠性。方法所有患者经纯音测听（PTA）检查筛选出中度感音神经性聋30例5～6岁儿童（共40耳），然后口服10％水合氯醛镇静睡眠后，行多频稳态听觉诱发电位（ASSR）检测，其阈值与纯音听阂阈值进行比较，分析不同频率处听力阈值分布情况及其相关性。结果分别比较语言频率ASSR阂值与纯音听闽阈值，结果显示，0．5kHz处相关性较差，其差值为2-18dB，而在4kHz处相关性最好。结论可以应用多频稳态听觉诱发电位评估中度感音神经性聋儿童的听力阈值，但需要注意0．5kHz处的相关性差异。     

Comparison of hearing thresholds obtained using pure-tone behavioral audiometry, the Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry

CONCLUSION: Speech thresholds measured using Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry (CERA) thresholds were highly correlated with pure-tone behavioral results. Both tests are considered to provide good estimates of hearing thresholds and can be employed to confirm the degree of hearing loss in Cantonese-speaking communities. OBJECTIVES: This study aimed to evaluate how well a speech threshold obtained using a newly developed speech assessment tool (the CHINT) and CERA thresholds relate to pure-tone behavioral results and how the results compared in terms of their ability to predict hearing thresholds. SUBJECTS AND METHODS: Thirty adults with normal hearing to profound sensorineural hearing loss were tested. Speech thresholds were measured using the CHINT in four conditions: quiet, noise from the front, noise from the right, and noise from the left. CERA thresholds were measured at 0.5, 1, 2, and 4 kHz in both ears. RESULTS: Most participants had speech thresholds in quiet within+/-10 dB of pure-tone averages, and had CERA thresholds within+/-15 dB of pure-tone thresholds. Speech and CERA thresholds were highly correlated (p<0.01) with pure-tone behavioral thresholds.     

68例感音神经性耳聋患者ASSR测试听阈与ABR测试V波反应阈的相关性研究

目的旨在探讨ASSR与ABR在诊断感音神经性耳聋中的相关性。方法68例临床诊断为感音神经性耳聋患者分别行0．5kHz，1kHz，2kHz，4kHzASSR测试及ABR测试，进行不同耳别、不同测试频率ASSR阈值与不同耳别ABRV波反应阈之间的相关分析。结果除了0．5kHz ASSR阈值与ABRV波反应阈的相关系数低而无显著意义外，1kHz，2kHz，4kHz ASSR阈值均与ABRV波反应阈有极显著性相关（P〈0．01），且随着测试频率的递增两者的相关系数随之增加，尤其是4kHz ASSR与ABRV波相关系数达到0．95以上（P〈0．01）。结论ASSR诊断感音神经性耳聋是可靠客观的，具有频率特性，可弥补ABR测试在诊断耳聋疾病中的频率局限性。     

成人感音神经性聋的听觉稳态反应反应阈与纯音听阈

目的探讨成人感音神经性聋的听觉稳态反应（auditory steady-state responses,ASSR）反应阈与纯音听阈的关系。方法选择中国医科大学附属一院耳鼻咽喉科门诊感音神经性聋的成人患者,分别进行纯音听力测试、ASSR检查,比较ASSR在0.5、1、2、4 kHz频率处的反应阈与纯音听阈的相关性及按听力损失程度比较两者的差值。结果 ASSR反应阈与纯音听阈在各频率处的相关系数分别为0.840、0.905、0.886、0.924;随着感音神经性听力损失的加重二者的差值明显缩小。随着频率的增加,两者的差值明显缩小。结论成人感音神经性聋ASSR反应阈与纯音听阈有显著相关性,随着听力损失的加重,ASSR反应阈愈接近纯音听阈,ASSR作为成人感音神经性聋听力定量诊断的客观方法有很大的临床应用价值。     

声场中记录的听性稳态助听反应阈与行为测试助听听阈的相关性

目的 应用多频听觉稳态反应(ASSR)Chirp刺激信号在声场中测试助听反应阈,观察其阈值与行为测试助听听阈的相关性,探讨多频听觉稳态反应Chirp刺激信号声场测试评估助听器补偿效果的临床意义.方法 选取22例(39耳)重度感音神经性听力损失、已配戴助听器的患儿(听障组)和16例(32耳)听力正常儿童(对照组)为研究对象.应用国际听力Eclipse EP25型多频稳态诱发电位仪及美国GSI-61型听力计,分别对听障组在声场中使用两种仪器测试助听听阈;对对照组进行裸耳行为听阈与声场中听觉稳态反应阈测试.结果 在0.5、1、2、4 kHz处,听障组ASSR助听反应阈与行为助听听阈的相关系数分别为0.65、0.68、0.77和0.82,P值均<0.01,显示两种测试结果有相关性;对照组裸耳行为听阈与声场中记录的听觉稳态反应阈在0.5、1、2、4 kHz配对t检验均呈显著差异(P<0.01),ASSR声场反应阈高于行为听阈20～30 dB HL.结论 应用多频听觉稳态反应Chirp刺激信号声场测试进行助听器补偿效果评估在临床上具有可行性.     

Multiple auditory steady-state responses in children and adults with normal hearing, sensorineural hearing loss, or auditory neuropathy

OBJECTIVES: We tested the clinical effectiveness of multiple auditory steady-state responses (ASSRs) for the objective assessment of hearing thresholds in patients with and without hearing loss, candidates for cochlear implants, and children with auditory neuropathy. METHODS: The study sample included 29 subjects with sensorineural hearing loss (SNHL), 18 candidates for cochlear implants, 11 subjects with auditory neuropathy, and 18 subjects with normal hearing thresholds. Behavioral hearing thresholds and ASSRs to carrier frequencies of 0.5, 1, 2, and 4 kHz were obtained. Special care was taken to minimize possible aliasing and high-intensity multiple stimulation effects. Differences and correlations between the ASSRs and the behavioral thresholds were determined. RESULTS: The ASSR estimation of behavioral thresholds in the normal-hearing group was elevated, whereas very close predictions were found for the SNHL group. The correlations between the two measures ranged from 0.86 at 0.5 kHz carrier frequency to 0.94 at 2 kHz. In the cochlear implant candidates and the auditory neuropathy group, the ASSR thresholds generally overestimated the behavioral audiogram. In these groups the number of detected ASSRs was higher than the number of behavioral responses, especially for the high-frequency carrier stimuli. CONCLUSIONS: Multiple ASSRs may reliably predict the behavioral threshold in subjects with SNHL and may serve as a valuable objective measure for assessing the hearing threshold across different frequencies in candidates for cochlear implants and children with auditory neuropathy.     

Hearing threshold estimation in infants using auditory steady-state responses

Successful early intervention in children with permanent hearing loss requires assessment techniques that can accurately reflect the behavioral audiogram in infancy. This retrospective study compared auditory steady-state response (ASSR) findings from subjects tested in the first three months of life with subsequently obtained behavioral hearing levels. ASSR audiograms were established using amplitude and frequency modulated tones at octave frequencies (500 Hz to 4 kHz). Results obtained from 575 subjects including 285 with normal hearing, 271 with sensorineural hearing loss, and 19 with auditory neuropathy-type hearing loss are presented. ASSR and behavioral hearing thresholds for subjects in the normal and sensorineural groups were highly correlated, with Pearson r values exceeding 0.95 at each of the test frequencies. In contrast, ASSR thresholds in children with AN-type hearing loss did not accurately reflect the behavioral audiogram. Overall, the findings indicate that ASSR testing can offer useful insights into the hearing acuity of children tested in infancy.     

Relationship between behavioral hearing thresholds and estimated auditory steady-state response thresholds in children with a history of neonatal hyperbilirubinemia

Increased serum bilirubin levels during infancy increase the risk of hearing loss in infants. This study aimed to investigate the relationship between pure-tone audiometry hearing thresholds and thresholds estimated using auditory steady-state responses (ASSRs) in children with a history of neonatal hyperbilirubinemia, and to evaluate the usefulness of 90-Hz ASSR in estimating hearing thresholds in children. This study was conducted on 26 children (13 girls and 13 boys) who were aged 2.4–11 years and had a history of neonatal hyperbilirubinemia (bilirubin level >17 mg/dL). ASSR thresholds were compared with behavioral thresholds and were interpreted after considering the amount and type of hearing loss. Of the 26 children, 12 had normal hearing thresholds, and 14 had varying degrees of sensorineural hearing loss. In general, a high correlation (r ≥ 0.81, p < 0.01) was found between the ASSR and behavioral thresholds. The highest correlation was observed at 2,000 Hz (r = 0.88, p < 0.01). No significant difference was observed (p > 0.13) between mean behavioral and ASSR thresholds at 52 studied ears. The results of this study showed that 90-Hz ASSR assessments provide reliable estimates of behavioral hearing thresholds in children who have a history of neonatal hyperbilirubinemia and sensorineural hearing loss or normal hearing.     

感音神经性聋成人不同刺激声ASSR反应阈与纯音听阈的相关性分析

目的探讨调制声听性稳态反应(ASSR)、 CE-Chirp ASSR用于评估感音神经性聋成人客观听力的价值。方法对78例(131耳)感音神经性聋成人同时进行纯音听阈和调制声ASSR、 CE-Chirp ASSR测试,比较0.5~4 kHz各频率纯音听阈与调制声ASSR、CE-Chirp ASSR反应阈的相关性及差值。结果 0.5、1、2、4 kHz CE-Chirp ASSR反应阈与纯音听阈的相关系数(分别为0.77、0.73、0.80、0.88)均高于调制声ASSR反应阈与纯音听阈的相关系数(分别为0.64、0.61、0.78、0.84),调制声ASSR、CE-Chirp ASSR反应阈与纯音听阈均具有显著相关性(圴为P<0.01);0.5~4 kHz CE-Chirp ASSR反应阈和纯音听阈的差值(分别为8.09±4.74、10.76±5.86、7.44±7.95、6.11±9.14 dB)均明显小于调制声ASSR反应阈和纯音听阈间的差值(分别为14.31±6.38、13.85±6.25、17.17±6.29、13.58±4.35 dB),差异均有统计学意义(均为P<0.05)。结论 CE-Chirp ASSR快捷可靠,较调制声ASSR能更好地评估感音神经性聋成人的听力。     

Establishing normal hearing with the dichotic multiple-frequency auditory steady-state response compared to an auditory brainstem response protocol

OBJECTIVE: To determine the clinical usefulness of the dichotic multiple-frequency (MF) auditory steady-state response (ASSR) technique for estimating normal hearing compared to a 0.5-kHz tone burst and broadband click auditory brainstem response (ABR) protocol in a sample of adults. MATERIAL AND METHODS: A comparative experimental research design was selected in order to compare estimations of normal hearing obtained with the dichotic ASSR technique at 0.5, 1, 2 and 4 kHz with a 0.5-kHz tone burst and broadband click ABR protocol. The recording times required for each procedure were also compared. Normal-hearing subjects (n = 28) were selected according to immittance values within normal limits and pure-tone behavioural thresholds of < 25 dB HL across frequencies. RESULTS: The dichotic MF ASSR estimated normal hearing to be, on average, 30-34 dB HL across the range 0.5-4 kHz. The mean estimate of normal hearing for 0.5 kHz using tone burst ABRs was 30 dB nHL and the mean click ABR threshold was 16 dB nHL, i.e. 14-18 dB better than the ASSR thresholds. The dichotic MFASSR technique recorded 8 thresholds (4 in each ear) in a mean time of 23 min. The ABR protocol recorded 4 thresholds (2 in each ear) in a mean time of 25 min. CONCLUSION: Both the dichotic MF ASSR and ABR protocols provided a time-efficient estimation of normal hearing. There was no significant difference between the tone burst ABR and MF ASSR techniques in terms of estimation of normal hearing at 0.5 kHz. The dichotic MF ASSR technique proved more time-efficient by determining more thresholds in a shorter time compared to the ABR protocol.     

Predicting pure-tone thresholds with dichotic multiple frequency auditory steady state responses

The accuracy of dichotic multiple frequency auditory steady state in predicting pure-tone thresholds at 0.5, 1, 2, and 4.0 kHz compared to an ABR protocol (click and tone burst at 0.5 kHz) were explored in a group of 25 hearing-impaired subjects across the degree and configuration spectrum. Mean steady state thresholds were within 14, 18, 15, and 14 dB of the pure tones at 0.5, 1, 2, and 4 kHz, compared to the tone-burst ABR at 0.5 kHz pure-tone difference of 24 dB, and a click-evoked pure-tone (2-4 kHz) difference of 9 dB. Recording time for the steady state protocol was 28 minutes (+/- 11) compared to 24 minutes (+/- 9) of the ABR protocol. Degree of loss had a significant effect on steady state; configuration of hearing loss had a limited effect. Mf ASSR predicted thresholds with relative accuracy although some configurations showed discrepancies for low-frequency estimates.     

感音神经性聋儿童听性稳态反应与行为听阈相关性分析

目的：分析感音神经性聋儿童听性稳态反应（auditory steady－state response,ASSR）与行为听阈的相关性。方法63例（126耳）重度或极重度感音神经性听力损失儿童,年龄0．5～6岁,按年龄分为 A 组（0．5～1．0岁,21例）,B 组（1．1～3．0岁,21例）,C 组（3．1～6．0岁,21例）;分别进行 ASSR 及小儿行为听阈测试,A 组采用行为观察测听（BOA）,B 组采用视觉强化测听（VRA）,C 组采用游戏测听（PA）,采用 SPSS17．0统计软件分析二种检查结果的相关性。结果①ASSR 反应阈与行为听阈在0．5、1、2和4 kHz 处的相关系数分别为0．75、0．76、0．76、0．83,呈极显著相关（P ＜0．01）。②小儿行为听阈值通常比 ASSR 反应阈值低,随着频率的增高,两者间差距缩小。③A 组（相关系数0．70）各频率 ABR 反应阈与行为听阈相关性均较 B（相关系数0．78）、C（相关系数0．83）组低。结论0．5～6．0岁感音神经性聋儿童 ASSR 与行为听阈值均有良好的相关性,ASSR 可预测感音神经性聋儿言语频率的客观听阈,为低龄儿童及难以检测行为听力的患儿验配助听器提供参考。     

Estimations of auditory sensitivity for young cochlear implant candidates using the ASSR: preliminary results

This paper presents preliminary results obtained with the use of the auditory steady-state response (ASSR) technique as part of a cochlear implant candidacy assessment protocol for infants. Fifteen infants (30 ears), between 10 and 60 months of age, with severe-to-profound hearing loss participated in the study. ASSR measurements were performed for 0.5, 1, 2 and 4 kHz at intensities up to 120–128 dB HL. The ASSR thresholds were obtained in 74% of the measurements, and exceeded the maximum auditory brainstem response (ABR) intensity output in 91% of cases and the maximum free-field behavioral intensity output in 84% of cases. Eighty-seven per cent of ASSR threshold measurements were measured at intensities of 100 dB HL or higher, and almost half (47%) were measured at intensities of 115 dB HL and higher. Preliminary results indicate that absent ABR and behavioral thresholds do not preclude the possibility of residual hearing, making the ASSR a primary source of information regarding profound levels of hearing loss.     

Auditory sensitivity in children using the auditory steady-state response

OBJECTIVE: To determine the effectiveness of auditory steady-state response (ASSR) as a measure of hearing sensitivity in young children suspect for significant hearing loss. DESIGN: Within-subject comparisons of click auditory brainstem response (ABR) thresholds and ASSR thresholds. SUBJECTS: The study population comprised 42 children suspect for hearing loss and subsequently referred for hearing assessment using electrophysiologic techniques. MAIN OUTCOME MEASURES: Electrophysiologic threshold responses for click ABR and ASSR stimuli (0.5, 1, 2, and 4 kHz) for right and left ears. RESULTS: Based on ABR and ASSR thresholds, 50% of the subjects demonstrated significant hearing loss in the severe to profound range. In some subjects, ASSRs were present at higher stimulus levels when click ABRs were absent. Significant correlations (P<.05) were found between high-frequency ASSR and click ABR thresholds for this study sample. For some subjects, ASSR findings suggested differences between ears that were not observable from the no-response click ABR results. CONCLUSIONS: Auditory steady-state response testing may provide additional information for children who demonstrate hearing levels in the severe to profound range. This information may be helpful when selecting the ear for cochlear implantation for a young hearing-impaired child. Multiple objective methods, such as ABR and ASSR testing, may be needed to determine accurate hearing sensitivity for young children being considered for sensory devices, and in particular, cochlear implants.     

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。     

Auditory steady state response in pediatric audiology

The main issue regarding pediatric audiology diagnosis is determining procedures to configure reliable results which can be used to predict frequency-specific hearing thresholds.AimTo investigate the correlation between auditory steady-state response (ASSR) with other tests in children with sensorineural hearing loss.MethodsProspective cross-sectional contemporary cohort study. Twenty-three children (ages 1 to 7; mean, 3 years old) were submitted to ASSR, behavioral audiometry, click audiometry brain stem response (ABR), tone burst ABR, and predicting hearing level from the acoustic reflex.Resultsthe correlation between behavioral thresholds and ASSR was (0.70- 0.93), for the ABR tone burst it was (0.73 -0.93), for the ABR click it was (0.83-0.89) only at 2k and 4 kHz. The match between the ASSR and the hearing threshold prediction rule was considered moderate.Conclusionthere was a significant correlation between the ASSR and audiometry, as well as between ABR click (2k and 4 kHz) and for the ABR tone burst. The acoustic reflex can be used to add information to diagnosis in children.     

Estimations of auditory sensitivity for young cochlear implant candidates using the ASSR: preliminary results

This paper presents preliminary results obtained with the use of the auditory steady-state response (ASSR) technique as part of a cochlear implant candidacy assessment protocol for infants Fifteen infants (30 ears), between 10 and 60 months of age, with severe-to-profound hearing loss participated in the study. ASSR measurements were performed for 0.5, 1, 2 and 4kHz at intensities up to 120-128dB HL. The ASSR thresholds were obtained in 74%, of the measurements, and exceeded the maximum auditory brainstem response (ABR) intensity output in 91% of cases and the maximum free-field behavioral intensity output in 84% of cases. Eighty-seven per cent of ASSR threshold measurements were measured at intensities of 100dB HL or higher, and almost half (47%) were measured at intensities of 115 dB HL and higher. Preliminary results indicate that absent ABR and behavioral thresholds do not preclude the possibility of residual hearing, making the ASSR a primary source of information regarding profound levels of hearing loss.