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.

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

OBJECTIVE

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+/-SD=2.8+/-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 (1 SD) 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 0.25 kHz, 39% of thresholds were at the minimum level of spurious response occurrence. More than half (54%) of the BC thresholds in the group with mild-to-moderate sensorineural hearing loss were recorded at or above the minimum levels at which spurious response occurred. In children with conductive hearing loss, the average BC ASSR thresholds corresponded closely to those in the normal hearing group except at 1 kHz and revealed an air-bone gap.

CONCLUSIONS

Spurious bone conduction ASSR responses limit the intensity range for which the technique may be employed in infants and children, especially at lower frequencies. Consequently, the 0.25 kHz stimulus is not recommended for clinical use. In infants and young children, sensorineural hearing loss of a moderate or greater degree in the high frequencies (1-4 kHz), and of a mild or greater degree in the low frequencies (0.5 kHz), cannot be quantified using BC ASSR. This is due to the presence of the stimulus artifact. In cases of conductive hearing loss, BC ASSR can effectively quantify sensory hearing between 0.5 and 4 kHz, but interpretations must be made cautiously within the limitations of stimulus artifact occurrence across frequencies.

Effects of Bone Oscillator Coupling Method, Placement Location, and Occlusion on Bone-Conduction Auditory Steady-State Responses in Infants

OBJECTIVE

The aim of these experiments was to investigate procedures used when estimating bone-conduction thresholds in infants. The objectives were: (i) to investigate the variability in force applied using two common bone-oscillator coupling methods and to determine whether coupling method affects threshold estimation, (ii) to examine effects of bone-oscillator placement on bone-conduction ASSR thresholds, and (iii) to determine whether the occlusion effect is present in infants by comparing bone-conduction ASSR thresholds for unoccluded and occluded ears.

DESIGN

Experiment 1A: The variability in the amount of force applied to the bone oscillator by trained assistants (n = 4) for elastic-band and hand-held coupling methods was measured. Experiment 1B: Bone-conduction behavioral thresholds in 10 adults were compared for two coupling methods. Experiment 1C: ASSR thresholds and amplitudes to multiple bone-conduction stimuli were compared in 10 infants (mean age: 17 wk) using two coupling methods. Experiment 2: Bone-conduction ASSR thresholds and amplitudes were compared for temporal, mastoid and forehead oscillator placements in 15 preterm infants (mean age: 35 wk postconceptual age (PCA)). Experiment 3: Bone-conduction ASSR thresholds, amplitudes and phase delays were compared in 13 infants (mean age: 15 wk) for an unoccluded and occluded test ear. All infants that participated had passed a hearing screening test.

RESULTS

Experiment 1A: Coupling method did not significantly affect the variability in force applied to the oscillator. Experiment 1B: There were no differences in adult bone-conduction behavioural thresholds between coupling methods. Experiment 1C: There was no significant difference between oscillator coupling method or significant frequency x coupling method interaction for ASSR thresholds or amplitudes in the young infants tested. However, there was a nonsignificant 9-dB better threshold at 4000 Hz for the elastic-band method. Experiment 2: Mean bone-conduction ASSR thresholds for the preterm infants were not significantly different for the temporal and mastoid placements. Mean ASSR thresholds for the forehead placement were significantly higher compared to the other two placements (12-18 dB higher on average). Mean ASSR amplitudes were significantly larger for the temporal and mastoid placements compared to the forehead placement. Experiment 3: There was no difference in mean ASSR thresholds, amplitudes or phase delays for the unoccluded versus occluded conditions.

CONCLUSIONS

Trained assistants can apply an appropriate amount of force to the bone oscillator using either the elastic-band or hand-held method. Coupling method has no significant effect on estimation of bone-conduction thresholds; therefore, either may be used clinically provided assistants are appropriately trained. For preterm infants, there are no differences in ASSRs when the oscillator is positioned at the temporal or mastoid placement. However, thresholds are higher and amplitudes are smaller for the forehead placement, consequently, a forehead placement should be avoided for clinical testing. There does not appear to be a significant occlusion effect in young infants; therefore, it may be possible to do bone-conduction testing with ears unoccluded or occluded without applying a correction factor, although further research is needed to confirm this finding.

Normative Wave V latency-intensity functions using the EARTONE 3A insert earphone and the Radioear B-71 bone vibrator

Early auditory evoked response (ABR) audiometry is useful for estimating auditory sensitivity in infants and other difficult-to-test populations. Several investigations advocate using bone-conducted stimuli, in addition to air-conducted stimuli, for screening infants with hearing loss or for ascertaining the presence and magnitude of a conductive hearing loss. The present study was designed to gather normative Wave V latency-intensity data with an insert earphone (EARTONE 3A) and a bone vibrator (Radioear B-71). Forty normal-hearing subjects were tested with air-conducted and bone-conducted clicks at intensities of 55, 40, 30, 20, and 10 dB SL. The stimulus waveforms showed a click onset delay of 0.1 ms for the 3A insert earphone. It is important to note that our ABR latencies were not adjusted to account for these differences. The results revealed that both the air-conduction and bone-conduction functions exhibited Wave V latencies of 7.0 ms at 55 dB SL. Although both functions exhibited increased latencies as intensity decreased to 10 dB SL, the air-conducted clicks yielded somewhat longer latencies than the bone-conducted clicks. To allow direct comparison of the air-conduction and bone-conduction latency-intensity function, the bone-conduction function must be corrected by approximately +0.3 ms at 40 dB, +0.4 ms at 30 dB, +0.5 ms at 20 dB, and +0.8 ms 10 dB nHL. No correction is needed at 55 dB. The present study suggests that it may not be appropriate to apply a single correction value (e.g., 0.5 ms) to the entire latency-intensity function. If clinicians elect to use published latency-intensity data, they must employ procedure similar to those that were used to collect the normative data. Otherwise, individual clinics should generate normative latency-intensity data using well-defined procedures. An alternative to generating latency-intensity functions is to compare ABR air-conduction and bone-conduction thresholds. This procedure is advantageous because threshold responses are not as sensitive as latency measures to slight changes in instrumentation and procedures. The normative air-conduction and/or bone-conduction values presented in this investigation are offered as a baseline for either latency-intensity or threshold comparisons.

Development of auditory function in the tammar wallaby Macropus eugenii

Auditory brainstem responses (ABRs) were evoked in developing wallabies by click and tone burst stimuli delivered by bone conduction and air conduction, at progressive stages of post-natal (pouch) life. ABRs were recorded through the onset of auditory responses (95-110 days), the opening of the external ear canal (125-130 days) and the maturation of ABR thresholds and latencies to values corresponding to those in adults ( > 180 days). ABRs were evoked in response to bone-conducted clicks some days prior to the age at which an acoustically evoked response was first observed (around 95 days of pouch life). ABRs could be evoked by bone-conducted and intense air-conducted stimuli prior to opening of the ear canal. A trend of decreasing threshold and latency with age was observed for both modes of stimulation. The morphology of the ABR became more complex, according to both increased age and increased stimulus intensity. The ABR waveforms indicated relatively greater mechanosensitivity to bone-conducted stimuli than to air-conducted stimuli, prior to opening of the ear canal. Following opening of the ear canal, thresholds to air-conducted clicks and tones were substantially reduced and decreased further over the next 10-20 days, while thresholds to bone-conducted clicks continued slowly to decrease. Thresholds to tone bursts in the centre frequency range (4-12 kHz) remained less than those for low (0.5-1.5 kHz) and higher (16 kHz) frequencies. Latencies of an identified peak in ABR waveforms characteristically decreased with age (at constant stimulus intensity) and with stimulus intensity (for a given age). ABR waveforms obtained at progressive ages, but judged to be at corresponding sensation levels, underwent maturational changes, independent of conductive aspects of the wallabies' hearing, for 2-3 weeks after opening of the ear canal.

Auditory brainstem response in tammar wallaby (Macropus eugenii)

Auditory brainstem responses (ABR) elicited by click and tonal stimuli were recorded from the tammar wallaby (Macropus eugenii), a marsupial mammal. The morphology, threshold, amplitude, and latency of ABRs recorded in the tammar wallaby are similar to those of other marsupials and mammals used in auditory research, including humans. Thresholds determined by an algorithm employing cross-correlation and by conventional visual detection methods were comparable. The findings from this study indicate that tammar wallaby is a suitable model for auditory research and that algorithms employing cross-correlation are useful for detection of the ABR waveform.