Clinical Application of Dichotic Multiple-Stimulus Auditory Steady-State Responses in High-Risk Newborns and Young Children

Abstract

Experience with dichotic multiple-stimulus auditory steady-state responses (ASSRs) in clinical practice is described. ASSR thresholds were assessed in a sample of 60 high-risk newborns and young children between birth and 4 years of age. Amplitudes and signal-to-noise ratios (SNRs) of the ASSR were compared between normal-hearing infants and adults. Age-related changes within a group of infants younger than 3 months of age were investigated. A comparison was made between ASSR, the click-evoked auditory brainstem response and behavioral hearing thresholds in infants with a wide range of hearing threshold levels. Mean ASSR thresholds for normal-hearing infants at an average corrected age of 12 days were 42 ± 10, 35 ± 10, 32 ± 10 and 36 ± 9 dB SPL for 0.5, 1, 2 and 4 kHz, respectively. Compared to adults, these thresholds were elevated by on average 11 dB and SNRs were 1.7 times smaller. However, based on ASSRs, reasonably accurate estimations could be made of behavioral hearing thresholds obtained at a later age (median delay of 7 months). The predicted thresholds were in 61% of the cases within 10 dB of the corresponding behavioral thresholds, and in 83% of the cases within 15 dB. In less than 1 h, thresholds at four frequencies per ear could be obtained. The optimal age of testing is between 1 week and 3 months corrected age. The dichotic multiple-stimulus ASSR technique is a valuable extension of the clinical test battery for hearing-impaired children, as a follow-up diagnostic after the neonatal hearing screening.

Auditory evoked potentials in premature and full-term infants

“…Analysis of the ASSR in our complete series showed that the mean minimum response was 13.8 dBHL (26.4 dBSPL) at 2 kHz. These data concur with other published results 11,20,23,26 . Very few studies have compared thresholds measured with tone burst ABR and ASSR in the same population 6,15,17,19,27 .…”

“…An additional issue is that most studies of these tests in children have been done with all subjects (or part of them) under sedation 3,[7][8][9][10][11][12][13][14][15][16][17] . A few studies of infants in natural sleep and adults have chosen one of the ears randomly 6,16,[18][19][20][21] or by recording the responses in two channels 22 .…”

Electrically Evoked Auditory Steady State Responses in Cochlear Implant Users

“…For modulated stimuli, recording of responses to multiple simultaneous stimuli is possible John et al 1998). ASSRs are used to predict hearing thresholds in adults (Rance et al 1995) as well as in infants (Rance and Rickards 2002;Luts et al 2006;Alaerts et al 2009), where correlations with behaviorally determined thresholds exceed 0.95. Menard et al (2004) described electrically evoked auditory steady state responses (EASSRs) in cochlear implant (CI) subjects.…”

Physiology, Psychoacoustics and Cognition in Normal and Impaired Hearing

“…There is therefore great interest in the clinical audiology community in the development of objective techniques to measure various hearing abilities that do not require behavioural responses from the patient and are able to determine fitting parameters for hearing aids and cochlear implants. While the use of cortical responses is in development (Billings et al 2007(Billings et al , 2011Carter et al 2010;Billings et al 2012;Chang et al 2012), transient brainstem responses and steady state responses (Luts et al 2004(Luts et al , 2006Alaerts et al 2010) are already used in clinical practice to objectively assess hearing thresholds in young children. However, while these measures provide an estimate of audibility with the prescribed hearing aid gain, they do not provide any indication of the expected hearing ability of the patient.…”