Thresholds of tone burst auditory brainstem responses for infants and young children with normal hearing in Taiwan

Normal reference values of low frequency specific air-conducted auditory brainstem responses among normal hearing children of different ages: A retrospective observational study

OBJECTIVES

To explore and compare the normal reference values (NRV) for low frequency specific air-conducted tone-burst auditory brainstem response (tb-ABR) among children of different ages and with normal hearing, because tb-ABR is often used to supplement the lack of click-evoked ABR (click-ABR) frequency but the NRV of this response threshold in different populations remain inconclusive.

METHODS

This retrospective observational study included children younger than 5 years of age with normal hearing in Hubei Province between November 2020 and September 2021. These children came to center of audiology for audiological examination including click-ABR due to different purposes and had accepted suggestion of tb-ABR test (0.5 kHz, 1 kHz). The children were divided into 5 groups according to age (0-12, 13-24, 25-36, 37-48, and 49-60 months of age), and 20 children (40 ears) met the inclusion criteria were selected from each group. The responding thresholds, peak latencies (PL), and inter-peak latencies (IPL) of the major waves were counted and compared in each group.

RESULTS

NRV of responding thresholds (dBnHL) in children aged 0-12, 13-24, 25-36, 37-48, and 49-60 months were 27.25 ± 9.47, 22.63 ± 5.31, 21.5 ± 5.33, 18.25 ± 5.83, and 21.63 ± 6.24 at 0.5 kHz, and 23.63 ± 7.16, 20.88 ± 7.06, 22 ± 4.21, 17.75 ± 6.09, and 21.38 ± 4.53 at 1 kHz, respectively. The response thresholds of children aged 0-12 months were significantly higher compared to children in other age groups at 0.5 kHz (all P < 0.05) and significantly higher than in children aged 37-48 months at 1 kHz (P < 0.05). There were significant differences among children of different ages in Wave III (P < 0.001) and Wave V (P < 0.001) in the peak latencies, and Waves I-III (P = 0.003) and Waves I-V (P < 0.001) in the inter-peak latencies at 0.5 kHz. Also, there were significant differences among children of different ages in Wave III and Wave V in the PL, and Waves I-III, Waves III-V, and Waves I-V in the IPL at 1 kHz (all P < 0.001).

CONCLUSION

The NRV of tb-ABR at 0.5 kHz and 1 kHz might differ among children of different ages. Newborn infants (<12 months old) might have a higher response threshold, while children aged 37-48 months might have a lower response threshold. However, it was a retrospective analysis with a small sample size, prospective contrast studies with larger samples are needed in the future.

Triagem auditiva escolar: identificação de alterações auditivas em crianças do primeiro ano do ensino fundamental

Resumo: OBJETIVO: caracterizar o perfil audiológico de escolares do primeiro ano do Ensino Fundamental da rede municipal da cidade de Caxias do Sul-RS, investigando e identificando a ocorrência de alterações auditivas nesta população, por meio de medidas eletroacústicas. MÉTODOS: estudo transversal, prospectivo, descritivo e quantitativo de 391 escolares do primeiro ano do Ensino Fundamental de escolas municipais da cidade de Caxias do Sul-RS. Os estudantes foram submetidos a quatro procedimentos audiológicos na Triagem Auditiva Escolar: Meatoscopia, Emissões Otoacústicas Evocadas por Estímulo Transiente, Emissões Otoacústicas - Produto de Distorção e Timpanometria. Além disso, os responsáveis pelas crianças responderam a um questionário com perguntas referentes ao desenvolvimento e aos antecedentes otológicos de cada criança. Os escolares que apresentaram alguma alteração auditiva na Triagem Auditiva foram encaminhados para avaliação otorrinolaringológica e/ou avaliação audiológica completa. RESULTADOS: das 782 orelhas avaliadas, 85,4% apresentaram normalidade nos exames realizados e 14,6% demonstraram algum tipo de alteração. Na Meatoscopia, verificou-se que 6,3% das orelhas apresentaram alterações. Passaram nas Emissões Otoacústicas Evocadas por Estímulo Transiente 94,8% das orelhas e nas Emissões Otoacústicas - Produto de Distorção 95,8%. Na Timpanometria, a curva predominante foi a tipo A, seguida pela tipo C. Foram realizados encaminhamentos para 14,6% dos escolares. CONCLUSÃO: a população desse estudo foi composta, em sua maioria, por escolares do gênero masculino, com seis anos de idade. Das 782 orelhas avaliadas, 85,4% apresentaram normalidade nos exames realizados e 14,6% demonstraram algum tipo de alteração.

Air and Bone Conduction Click and Tone-Burst Auditory Brainstem Thresholds Using Kalman Adaptive Processing in Nonsedated Normal-Hearing Infants

OBJECTIVES

To study normative thresholds and latencies for click and tone-burst auditory brainstem response (TB-ABR) for air and bone conduction in normal infants and those discharged from neonatal intensive care units, who passed newborn hearing screening and follow-up distortion product otoacoustic emission. An evoked potential system (Vivosonic Integrity) that incorporates Bluetooth electrical isolation and Kalman-weighted adaptive processing to improve signal to noise ratios was employed for this study. Results were compared with other published data.

DESIGN

One hundred forty-five infants who passed two-stage hearing screening with transient-evoked otoacoustic emission or automated auditory brainstem response were assessed with clicks at 70 dB nHL and threshold TB-ABR. Tone bursts at frequencies between 500 and 4000 Hz were used for air and bone conduction auditory brainstem response testing using a specified staircase threshold search to establish threshold levels and wave V peak latencies.

RESULTS

Median air conduction hearing thresholds using TB-ABR ranged from 0 to 20 dB nHL, depending on stimulus frequency. Median bone conduction thresholds were 10 dB nHL across all frequencies, and median air-bone gaps were 0 dB across all frequencies. There was no significant threshold difference between left and right ears and no significant relationship between thresholds and hearing loss risk factors, ethnicity, or gender. Older age was related to decreased latency for air conduction. Compared with previous studies, mean air conduction thresholds were found at slightly lower (better) levels, while bone conduction levels were better at 2000 Hz and higher at 500 Hz. Latency values were longer at 500 Hz than previous studies using other instrumentation. Sleep state did not affect air or bone conduction thresholds.

CONCLUSIONS

This study demonstrated slightly better wave V thresholds for air conduction than previous infant studies. The differences found in the present study, while statistically significant, were within the test step size of 10 dB. This suggests that threshold responses obtained using the Kalman weighting software were within the range of other published studies using traditional signal averaging, given step-size limitations. Thresholds were not adversely affected by variable sleep states.

Potencial evocado auditivo de tronco encefálico por frequência específica por via aérea e via óssea em neonatos ouvintes normais

Objetivo determinar os níveis mínimos de resposta (NMR) e a latência da onda V do Potencial Evocado Auditivo de Tronco encefálico por Frequência específica (PEATE-FE) em neonatos ouvintes normais nas frequências de 0.5, 1, 2 e 4 kHz por via aérea e via óssea e determinar valores normativos. Métodos foram avaliados neonatos com audição normal, sendo realizado o PEATE-FE nas frequências de 0.5, 1, 2 e 4 kHz, tanto por via aérea (VA) quanto por via óssea (VO). Para cada frequência, foram avaliadas 12 orelhas em um total de 18 neonatos. A análise dos resultados avaliou o tempo de latência e a presença da onda V até a intensidade de 20 dBnNA para quatro intensidades e para os dois tipos de condução (aérea e óssea). Resultados observou-se aumento da latência da onda V com a diminuição da intensidade e maiores latências nas frequências mais baixas, tanto na VA quanto na VO. Porém, em fortes intensidades, em ambas condições, não houve diferença entre as latências de 0.5 e 1 kHz, contrariando os achados da literatura. Para VA, na frequência de 500 Hz, houve presença da onda V até 30 dBnNA em todas as orelhas, e em 1000 Hz, 11 orelhas (91,66 %) apresentaram resposta em 20 dBnNA; nas demais frequências, 100% das orelhas avaliadas apresentaram resposta em 20 dBnNA. Na VO, a presença da onda V em 20 dBnNA foi observada em todas as frequências estudadas. Conclusão os valores descritos podem ser considerados normativos e utilizados na clinica como padrão de normalidade, auxiliando no diagnóstico diferencial da perda auditiva ao nascimento.

Auditory brainstem responses to bone-conducted brief tones in young children with conductive or sensorineural hearing loss

The bone-conduction (BC) tone ABR has been used clinically for over 20 years. The current study formally evaluated the test performance of the BC tone-evoked ABR in infants with hearing loss. Method. By comparing BC-ABR results to follow-up behavioural results, this study addressed two questions: (i) whether the BC tone ABR was successful in differentiating children with conductive versus sensorineural hearing loss (Study A; conductive: 68 ears; SNHL: 129 ears) and (ii) the relationship between BC ABR and behavioural hearing loss severity (Study B: 2000 Hz: 104 ears; 500 Hz: 47 ears). Results. Results demonstrate that the "normal" BC-ABR levels accurately differentiated normal versus elevated cochlear sensitivity (accuracy: 98% for 2000 Hz; 98% for 500 Hz). A subset of infants in Study A with elevated BC-ABR (i.e., no response at normal level) had additional testing at higher intensities, which allowed for categorization of the degree of cochlear impairment. Study B results indicate that the BC ABR accurately categorizes the degree of cochlear hearing loss for 2000 Hz (accuracy = 95.2%). A preliminary dBnHL-to-dBHL correction factor of "0 dB" was determined for 2000 Hz BC ABR. Conclusions. These findings further support the use of BC tone ABR for diagnostic ABR testing.

Tone burst evoked otoacoustic emissions in neonates

Aim

Materials and Methods

Study

Results

Conclusion

Effects of age and degree of hearing loss on the agreement and correlation between sound field audiometric thresholds and tone burst auditory brainstem response thresholds in infants and young children

BACKGROUND/PURPOSE

Early hearing rehabilitation programs eventually require measurement of the hearing threshold cutoff values over the whole range of speech frequencies. With tone burst auditory brainstem responses, excellent agreement and correlation between evoked-potential and behavioral thresholds have been demonstrated by previous studies. This study investigated the effects of different ages and degrees of hearing loss on the agreement and correlation in a large series of infants and young children in Taiwan.

METHODS

Medical records were reviewed from a large series of 1281 infants and young children aged from 3 months to 3 years who had undergone diagnostic audiometry, including sound field audiometry and tone burst auditory brainstem response measurements. The effects of age and hearing loss on the agreement and correlation between two measured thresholds were studied.

RESULTS

Significant correlations (p < 0.001) were seen between the two measured thresholds across groups of different ages and different degrees of hearing loss greater than 20 dB HL. However, the degree of correlation deteriorated at lower degrees of hearing loss. Correlations for hearing thresholds less than 20 dB HL were not significant at 1000, 2000 and 4000 Hz.

CONCLUSION

The evoked-potentials test, properly obtained and interpreted with respect to the effects of age and degree of hearing loss, may provide a very informative hearing threshold reference to help in behavioral audiometric evaluation in infants and young children with hearing loss.