The Impact of Degree of Hearing Loss on Auditory Brainstem Response Predictions of Behavioral Thresholds

Abstract

Objectives: Diagnosis of hearing loss and prescription of amplification for infants and young children require accurate estimates of ear- and frequency-specific behavioral thresholds based on auditory brainstem response measurements. Although the overall relationship between ABR and behavioral thresholds has been demonstrated, the agreement is imperfect, and the accuracy of predictions of behavioral threshold based on ABR may depend on degree of hearing loss. Behavioral thresholds are lower than ABR thresholds, at least in part due to differences in calibration interacting with the effects of temporal integration, which are manifest in behavioral measurements but not ABR measurements and depend on behavioral threshold. Listeners with sensory hearing loss exhibit reduced or absent temporal integration, which could impact the relationship between ABR and behavioral thresholds as degree of hearing loss increases. The current study evaluated the relationship between ABR and behavioral thresholds in infants and children over a range of hearing thresholds, and tested an approach for adjusting the correction factor based on degree of hearing loss as estimated by ABR measurements. Design: A retrospective review of clinical records was completed for 309 ears of 177 children with hearing thresholds ranging from normal to profound hearing loss and for whom both ABR and behavioral thresholds were available. Children were required to have the same middle-ear status at both evaluations. The relationship between ABR and behavioral thresholds was examined. Factors that potentially could affect the relationship between ABR and behavioral thresholds were analyzed, including degree of hearing loss observed on the ABR, behavioral test method (visual reinforcement, conditioned play or conventional audiometry), the length of time between ABR and behavioral assessments, and clinician-reported reliability of the behavioral assessment. Predictive accuracy of a correction factor based on the difference between ABR and behavioral thresholds as a function of ABR threshold was compared to the predictive accuracy achieved by two other correction approaches in current clinical use. Results: As expected, ABR threshold was a significant predictor of behavioral threshold. The relationship between ABR and behavioral thresholds varied as a function of degree of hearing loss. The test method, length of time between assessments and reported reliability of the behavioral test results were not related to the difference between ABR and behavioral thresholds. A correction factor based on the linear relationship between the differences in ABR and behavioral thresholds as a function of ABR threshold resulted in more accurately predicted behavioral thresholds than other correction factors in clinical use. Conclusions: ABR is a valid predictor of behavioral threshold in infants and children. A correction factor that accounts for the effect of degree of hearing loss on the difference between ABR and behavioral thresholds resulted in more accurate pred...

Conventional Amplification for Children and Adults with Severe-to-Profound Hearing Loss

“…Electrophysiologic testing, such as an auditory brainstem response (ABR), is considered an essential piece of diagnostic testing for infants and children who are not yet able to complete behavioral testing. 58 Research by McCreery et al 59 reconfirmed that ABR thresholds are a strong predictor of a child's behavioral thresholds; however, the amount of accuracy between the ABR thresholds and behavioral thresholds depends on the degree of hearing loss. For infants who have a severe-to-profound hearing loss, a potential exists for the accuracy of their ABR thresholds to be poorer.…”

“…According to McCreery et al, 59 ABR thresholds often underestimate the hearing loss for individuals who have a moderate or greater degree of hearing loss. To account for differences between ABR threshold and behavioral threshold for individuals with greater degrees of hearing loss, a frequency-specific correction factor was developed.…”

Altered Potassium Ion Homeostasis in Hearing Loss

“…Auditory brain stem responses are far-field potentials that measure all ranges of the early auditory evoked potentials (AEP) using signal averaging [52,53]. It consists of a series of seven waves (I-VII.)…”

“…Neural responses during an auditory brainstem response test (ABR) are generated subcortically by the auditory nerve and subsequent brain stem fiber tracts and nuclei. Using either click or chirp stimuli is still the gold standard for electro-physiologically assessing the integrity of the auditory nerve and the brain stem pathways as they lead the electrical stimuli towards the cortex [52][53][54][55] ( Figure 1C and D). Neuronal junction points in the brainstem as generator relay structures are identified in the form of waves on the electrophysiological recordings in normal subjects ( Figure 1C); while these points are not registered in patients with a profound hearing loss (Figure 1D).…”

Unraveling the Mystery of Auditory Brainstem Response Corrections: The Need for Universal Standards

“…Despite there being no universally adopted method to define nHL, ABR thresholds in dB nHL are highly and positively correlated with pure-tone behavioral hearing thresholds in dB HL (Stapells et al, 1995;Gorga et al, 2006;Vander Werff et al, 2009;McCreery et al, 2015). For example, McCreery et al (2015) found correlations .0.87 while Stapells et al (1995) found correlations .0.93 between ABR and behavioral hearing thresholds in children.…”