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.     

60例军校男女学员ASSR测试研究

目的旨在观察正常年轻人多频稳态诱发电位（ASSR）测试的正常值特点。方法对60例第一军医大学学员行ASSR、ABR和电测听测试，比较男．女及左、右耳测试值的差异。结果ASSR0．5kHz、1kHz、2kHz、4kHz测试值均数与纯音听闻均数各频率的差值分别为13．86dBHL、14．63dBHL、13．06dBHL．15．28dBHL；ASSR0．5kHz、1kHz、2kHz、4KHz测试值均数与ABRV波反应阈的差值分别为6．14dBHL、5．37dBHL、6．94dBHL、4．72dBHL；男、女学员ASSR测试值比较无显著性差异（P〉0．05）。结论ASSR正常值不受性别．耳别的影响；用ASSR测试值来推断预估纯音听阈．ABRV波反应阈要综合考虑各频率的差值。     

Threshold prediction using the auditory steady-state response and the tone burst auditory brain stem response: a within-subject comparison

OBJECTIVE: The purpose of this study was to evaluate the accuracy with which auditory steady-state response (ASSR) and tone burst auditory brain stem response (ABR) thresholds predict behavioral thresholds, using a within-subjects design. Because the spectra of the stimuli used to evoke the ABR and the ASSR differ, it was hypothesized that the predictive accuracy also would differ, particularly in subjects with steeply sloping hearing losses. DESIGN: ASSR and ABR thresholds were recorded in a group of 14 adults with normal hearing, 10 adults with flat, sensorineural hearing losses, and 10 adults with steeply sloping, high-frequency, sensorineural hearing losses. Evoked-potential thresholds were recorded at 1, 1.5, and 2 kHz and were compared with behavioral, pure-tone thresholds. The predictive accuracy of two ABR protocols was evaluated: Blackman-gated tone bursts and linear-gated tone bursts presented in a background of notched noise. Two ASSR stimulation protocols also were evaluated: 100% amplitude-modulated (AM) sinusoids and 100% AM plus 25% frequency-modulated (FM) sinusoids. RESULTS: The results suggested there was no difference in the accuracy with which either ABR protocol predicted behavioral threshold, nor was there any difference in the predictive accuracy of the two ASSR protocols. On average, ABR thresholds were recorded 3 dB closer to behavioral threshold than ASSR thresholds. However, in the subjects with the most steeply sloping hearing losses, ABR thresholds were recorded as much as 25 dB below behavioral threshold, whereas ASSR thresholds were never recorded more than 5 dB below behavioral threshold, which may reflect more spread of excitation for the ABR than for the ASSR. In contrast, the ASSR overestimated behavioral threshold in two subjects with normal hearing, where the ABR provided a more accurate prediction of behavioral threshold. CONCLUSIONS: Both the ABR and the ASSR provided reasonably accurate predictions of behavioral threshold across the three subject groups. There was no evidence that the predictive accuracy of the ABR evoked using Blackman-gated tone bursts differed from the predictive accuracy observed when linear-gated tone bursts were presented in conjunction with notched noise. Similarly, there was no evidence that the predictive accuracy of the AM ASSR differed from the AM/FM ASSR. In general, ABR thresholds were recorded at levels closer to behavioral threshold than the ASSR. For certain individuals with steeply sloping hearing losses, the ASSR may be a more accurate predictor of behavioral thresholds; however, the ABR may be a more appropriate choice when predicting behavioral thresholds in a population where the incidence of normal hearing is expected to be high.     

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.     

Comparison of auditory steady-state responses and tone-burst auditory brainstem responses in normal babies

OBJECTIVE: To follow the development of tone-burst auditory brainstem response (TB-ABR) and auditory steady-state response (ASSR) thresholds in a group of normal babies through the first 6 wk of life. DESIGN: This longitudinal study involved assessment at four data-collection points. TB-ABR and ASSR thresholds to 500-Hz and 4-kHz stimuli were established in 17 full-term subjects at 0, 2, 4, and 6 wk of age. Stimulus-modulation rates for ASSR assessment were 74 Hz (for 500-Hz tones) and 95 Hz (for 4-kHz tones). TB-ABR responses were recorded to stimuli presented at 39.1 Hz. RESULTS: Mean ASSR thresholds (calibrated in dBHL) at 500 Hz ranged from 44.4 to 39.7 dB HL across the recording period, and at 4 kHz they ranged from 37.9 to 32.1 dB HL. TB-ABR thresholds (calibrated in dBnHL) were significantly lower, ranging from 36.8 to 36.2 dB nHL at 500 Hz and from 16.5 to 15.9 dB nHL at 4 kHz. However, when the stimuli used for each test were calibrated in the same units (peak equivalent dB SPL), the results were similar. That is, the differences between the two techniques were only an artifact of the calibration. ASSR thresholds were more variable than TB-ABR, particularly at the neonatal measurement point. Within-subject changes across the test period were observed for ASSR thresholds but not for TB-ABR. CONCLUSIONS: The longitudinal findings presented in this study suggest that for normal neonates, the TB-ABR technique may offer a more reliable basis for prediction of hearing levels than ASSR assessment. This is not because TB-ABR thresholds (calibrated in dBnHL) are lower, but because the response is less affected by maturational development in the first weeks of life and is less variable across subjects.     

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.     

短声与短纯音ABR波V阈值的相关性比较

目的研究分别用短声与短纯音作为刺激声的听觉脑干诱发电位（auditory braistem response，ABR）波V阈值测试结果的相关性，以探讨短纯音ABR的临床应用价值。方法分别用短声和短纯音ABR对患者进行波V阈值的测试。结果测试的31耳中，短声与短纯音ABR500Hz～4000Hz的波V阈值的相关系数分别为：0．480、0．583．0．752和0．811。P值均为0。结论短声和短纯音ABR波V阈之间有相关性。其中，2000～4000Hz的相关性优于500～1000Hz；当听力损失大于70dBnHL时的500～1000Hz的相关性好于听力损失小于70dBnHL的时候。提示当短声ABR波V阈值大于70dBnHL时同样可以预测0．5kHz、1kHz短纯音ABR波V阈值。     

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.     

正常青年人短纯音ABR和ASSR的相关性研究

目的比较正常青年人短纯音听性脑干反应（auditory brainstem response，ABR）和听性稳态反应（auditory steady-state response，ASSR）反应阈的差异及相关性。方法对10名（20耳）听力正常青年人进行短纯音ABR和ASSR反应阈测试，分别记录0．5．1、2和4 kHz的反应阈，比较这两种不同测试方法所得反应阈的特点及相关性。结果短纯音ABR和ASSR反应阈无显著性差异（P〉O．05），两者在0．5、1、2和4 kHz处的相关系数分别为0．49、0．52．0．64和0．76。结论正常青年人短纯音ABR反应阈和ASSR反应阈存在一定的相关性，高频处的相关性较低频好。     

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.     

Predictive value of hearing assessment by the auditory brainstem response following universal newborn hearing screening

Abstract

Objective: This study set out to determine the accuracy with which tone pip ABR and click ABR, carried out in babies referred from universal newborn hearing screening, is able to predict the hearing outcome as determined by follow-up hearing tests. Study sample: The cohort of babies studied were all babies referred for hearing assessment from the universal newborn hearing screen in Sheffield, UK for the period January 2002 to September 2007, who were found to have a significant hearing impairment. Design: The results of hearing assessment following referral from the newborn hearing screen were collected together with those of follow-up tests carried out up to an age when behavioural testing had established ear- and frequency-specific thresholds at 0.5, 1, 2 and 4 kHz. Results: The standard deviation of the difference between the follow up and the tone pip ABR thresholds was 10.5 dB for the 4-kHz tone pip, 16.8 dB for the 1-kHz tone pip, and ranged between 21.7 and 24.7 dB for click ABR. Conclusions: The results of the study show that tone pip ABR following referral from newborn hearing screening has a similar accuracy to that reported in older subjects, and is a much better predictor compared to click ABR.     

Thresholds determined using the monotic and dichotic multiple auditory steady-state response technique in normal-hearing subjects

Auditory steady-state responses (ASSRs) were elicited by presenting single or multiple, 77-105 Hz amplitude-modulated 0.5, 1, 2, and 4 kHz tones to one or both ears. Objectives of this study were to (i) replicate and extend previous multiple ASSR studies in a quiet double-walled sound booth, and (ii) discover differences (if any) between thresholds assessed in monotic and dichotic conditions, which ranged between 15 and 22dB SPL. The present study's behavioural and ASSR thresholds are 0-10 dB lower (better) than results of previous monotic studies. Further, there are no significant differences in ASSR thresholds between dichotic and monotic stimulus conditions. Therefore, dichotic multiple AM tone stimulation does not produce a change in the ASSR that affects threshold estimation in a clinically significant manner. Thus, at least for detecting normal hearing, the dichotic multiple ASSR technique is a feasible method for estimating hearing thresholds that would substantially reduce recording time compared to conventional single-stimulus techniques.     

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.     

短纯音诱发的听性脑干反应测试中声诱发短潜伏期负反应研究

目的 总结在有听力损失儿童中行短纯音诱发的听性脑干反应(tbABR)测试时记录到的声诱发短潜伏期负反应(acoustically short latency negative response,ASNR)的特点.方法 在有听力损失的0～6岁儿童中应用SmartEP听觉诱发电位仪记录短声和短纯音ABR的反应阈,在记录到ASNR的受试者中分析其反应阈和潜伏期.结果 在所有80受试耳中共7耳(8.75%)在cABR测试中引出ASNR,40耳(50%)在tbABR测试中引出ASNR,其中1 kHz引出率最高(37耳,46.25%),2 kHz次之(25耳,31.25%).引出ASNR者ABR波V反应阈最低65 dB nHL,ASNR反应阈最低80 dB nHL.0.5、1、2和4 kHz短纯音诱发的ASNR潜伏期分别为6～8、5～7、3～5、3～4 ms.随刺激强度的增加,其潜伏期缩短.结论 有听力损失的儿童tbABR测试中可以记录到AS-NR,但不影响以波V反应阈评估听力.     

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.     

正常青年人多频稳态听觉诱发反应测试

目的 :测定正常青年人多频稳态听觉诱发反应 (ASSR)阈值 ,为临床诊断提供客观依据。方法 :选正常青年人 2 2例 (4 4耳 ) ,行ASSR阈值测试。结果 :在 0 .2 5～ 8.0kHz频区间 ,ASSR平均阈值约在 4 0～ 6 0dBHL之间 ,从低频到高频其阈值越来越高 ,0 .2 5kHz、0 .5kHz、1.0kHz处的ASSR平均阈值约为 4 0dBHL ,2 .0kHz处约为 4 5dBHL ,4 .0kHz处约为 5 0dBHL ,8.0kHz处约为 6 0dBHL。ASSR阈值与纯音听阈间差值多在2 5～ 5 5dBHL之间 ,从低频到高频其阈差值越来越高 ,0 .2 5kHz处的差值约为 2 5dBHL ,0 .5kHz处约30dBHL ,1.0kHz处约 35dBHL ,2 .0kHz处约 4 0dBHL ,4 .0kHz处约 5 0dBHL ,8.0kHz处约 5 5dBHL。结论 :正常青年人ASSR阈值与纯音听阈间有一定差值。利用这一差值 ,通过测试ASSR阈值可推断出被检查者纯音听阈的阈值     

Relationship between pure tone audiometry and tone burst auditory brainstem response at low frequencies gated with Blackman window

To assess the reliability of Blackman windowed tone burst auditory brainstem response (ABR) as a predictor of hearing threshold at low frequencies. Fifty-six subjects were divided in to three groups (normal hearing, conductive hearing loss, sensorineural hearing loss) after pure tone audiometry (PTA) testing. Then they underwent tone burst ABR using Blackman windowed stimuli at 0.5 kHz and 1 kHz. Results were compared with PTA threshold. Mean threshold differences between PTA and ABR ranged between 11 dB at 0.5 kHz and 14 dB at 1 kHz. ABR threshold was worse than PTA in each but 2 cases. Mean discrepancy between the two thresholds was about 20 dB in normal hearing, reducing in presence of hearing loss, without any differences in conductive and sensorineural cases. Tone burst ABR is a good predictor of hearing threshold at low frequencies, in case of suspected hearing loss. Further studies are recommended to evaluate an ipsilateral masking such as notched noise to ensure greater frequency specificity.     

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.     

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.     

Frequency-selective auditory brain-stem response in newborns and infants

The efficacy of the frequency-selective auditory brain-stem response (ABR) in new borns and infants was assessed using an auditory stimulus of a 1-kHz tone pip and compared with the results of click-evoked ABR. In subjects whose responses to conventional behavioral audiometry were obtained at intensities of 40 to 70 dB, the ABR thresholds evoked by 1-kHz tone pips and clicks lay between 5 and 20 dB hearing threshold level (HTL). In subjects who did not respond to conventional behavioral audiometry at the intensity of 70 dB, ABR thresholds in each auditory stimulus were elevated by 35 to 70 dB HTL, and no responses were noted at 80 to 90 dB HTL. These results indicate that frequency-selective ABR can be applied clinically as an objective method of audiometry for newborns and infants.