Auditory steady-state responses to bone conduction stimuli in children with hearing loss

Abstract

SummaryObjective: The auditory steady-state response (ASSR) to air-conduction (AC) stimuli has been widely incorporated into audiological test-batteries for the pediatric population. The current understanding of ASSR to bone conduction (BC) stimuli, however, is more limited, especially in the case of infants and children. There are few reports on ASSR thresholds to BC stimuli in infants and young children, and none for infants or children with hearing loss. The objective of this study was to investigate BC ASSR thresholds in young children with normal hearing and various types and degrees of hearing loss. Methods: AC and BC ASSR thresholds are reported for 48 young children (mean age AE SD = 2.8 AE 1.9 years; age range = 0.25-11.5 years; 23 female). Hearing status was classified by assessing all children with a comprehensive test battery including tympanometry, diagnostic distortion-product otoacoustic emissions, click-evoked AC auditory brainstem response, AC and BC ASSR thresholds, and an otologic examination. The subjects were assigned to the categories normal hearing, conductive loss, and sensorineural loss (mild-to-moderate or severe-to-profound), for group analysis. AC and BC ASSR stimuli (carrier frequencies: 0.25-4 kHz; 67-95 Hz modulation rates; 100% amplitude and 10% frequency modulated) were presented using the GSI Audera system. Results: : Minimum levels at which spurious BC ASSR occur were established in the group of children with severe-to-profound sensorineural hearing loss (25, 40, 60, 60 and 60 dB for 0.25, 0.5, 1, 2, and 4 kHz, respectively). Children with normal hearing presented mean (1SD) BC ASSR thresholds of 19 (9), 18 (7), 16 (11), 24 (7), and 26 (8) dB HL at 0.25, 0.5, 1, 2, and 4 kHz, respectively. Significantly lower thresholds ( p < 0.0001) were obtained for 0.25, 0.5 and 1 kHz than for 2 and 4 kHz. At

Maturation of Mechanical Impedance of the Skin-Covered Skull: Implications for Soft Band Bone-Anchored Hearing Systems Fitted in Infants and Young Children

“…The present study has provided some insight into the mechanical properties of the skin-covered skull of infants and young children and has suggested possible links between these properties and the maturational trends we observe for bone conduction hearing sensitivity (Stapells & Ruben 1989;Nousak & Stapells 1992;Foxe & Stapells 1993;Small & Stapells 2006;Small & Stapells 2008;Swanepoel et al 2008;Hulecki & Small 2011;Casey & Small 2014). Although we have not confirmed the link between mechanical impedance differences with maturation and output to the cochlea, some of the findings from this study may have practical clinical applications.…”

Comparisons of Auditory Steady State Response and Behavioral Air Conduction and Bone Conduction Thresholds for Infants and Adults With Normal Hearing

“…There are several studies that have reported BC ASSR thresholds in individuals with normal hearing which consistently show that thresholds are better in the low frequencies compared with the high frequencies in young and older infants compared with the frequencies in adults (e.g., Small & Stapells 2006. However, there is currently only one published study that estimated BC ASSRs in children with hearing loss (Swanepoel et al 2008). This study provides relatively limited information as it estimated thresholds for a wide age range (3 months to 11.5 years) and did not confirm the accuracy of the ASSR results by comparing thresholds with a gold standard tool.…”

Clinical Status of the Auditory Steady-State Response in Infants

“…2 Current research indicates that reliable bone conduction thresholds can be obtained in preterm, term, and older infants with normal hearing. [23][24][25][26] A maturational effect suggests that bone conduction ASSR thresholds improve in the high frequencies and deteriorate in the low frequencies as illustrated in Fig. 2.…”

“…2. A series of studies investigating the procedural factors that may influence the measurement of bone conduction ASSR thresholds in infants [23][24][25][26] recommend the following: (1) coupling the bone oscillator can be done with an elastic band or be handheld with training; (2) forehead placement should be avoided but temporal and mastoid placement is appropriate; (3) occlusion does not have a significant effect on threshold estimation; (4) interaural attenuation for infants with bone conduction is greater than for adults (at least 10 to 30 dB), making isolation of the test cochlea easier.…”