Hearing threshold estimation by auditory steady state responses (ASSR) in children

Automated detection of auditory response: non-detection stopping criterion and repeatability studies for multichannel EEG

An Auditory Steady-State Response (ASSR) is a valuable tool for determining auditory thresholds in individuals who are either unable or unwilling to cooperate with conventional behavioral testing methods. This study proposes a sequential test technique for automatic detection of ASSRs, incorporating a non-detection stopping criterion. The electrophysiological thresholds of a normal hearing volunteer were established using data collected from multichannel EEG signals. The detection probabilities and critical values were obtained via Monte Carlo simulations. Remarkably, application of the non-detection stopping criterion resulted in a 60% reduction in exam time in the absence of a response. These findings clearly demonstrate the significant potential of the sequential test in enhancing the performance of automatic audiometry.

Analysis of predictive factors related to long-term hearing and temporal bone development in congenital microtia

OBJECTIVE

To investigate the predictive factors of long-term hearing threshold and temporal bone development in children with congenital microtia (CM).

METHODS

74 patients (92 ears) with CM enrolled, which all had auditory brainstem response (ABR) results during infancy or toddlerhood, pure tone audiometry (PTA) and high-resolution computed tomography (HRCT) results during childhood or adolescence, and had not undergone any surgery. We compared the relationship between ABR, auditory steady-state response (ASSR), the affected side, auricular morphology, presence of external auditory canal stenosis or atresia, PTA average, mastoid pneumatization, Jarhsdoerfer scores, and wether cholesteatoma exists.

RESULTS

The average age of ABR in 92 ears was 2.72 ± 3.52 years old, PTA was 7.26 ± 2.51 and HRCT was 6.91 ± 2.76 years old. ABR-AC was related to PTA average, mastoid pneumatization, Jarhsdoerfer scores, and wether cholesteatoma exists in CM. While ABR-ABG was related to all of these factors except Jarhsdoerfer score, and ABR-BC had no relationship with any of them. ASSR only showed correlation with frequencies of 1, 2 kHz and was related to Jarhsdoerfer score, with no other correlations observed. The impaired ear side showed no relevance. However, auricular morphology was related to all of these factors except wether cholesteatoma exist. External auditory canal stenosis or atresia was related to PTA average, but unrelated to mastoid pneumatization.

CONCLUSION

The ABR examination in the infant stage plays a crucial role in predicting the long-term hearing and temporal bone development in patients with CM.

Auditory steady-state responses during and after a stimulus: Cortical sources, and the influence of attention and musicality

The auditory steady-state response (ASSR) is an oscillatory brain response generated by periodic auditory stimuli and originates mainly from the temporal auditory cortices. Recent data show that while the auditory cortices are indeed strongly activated by the stimulus when it is present (ON ASSR), the anatomical distribution of ASSR sources involves also parietal and frontal cortices, indicating that the ASSR is a more complex phenomenon than previously believed. Furthermore, while the ASSR typically continues to oscillate even after the stimulus has stopped (OFF ASSR), very little is known about the characteristics of the OFF ASSR and how it compares to the ON ASSR. Here, we assessed whether the OFF and ON ASSR powers are modulated by the stimulus properties (i.e. volume and pitch), selective attention, as well as individual musical sophistication. We also investigated the cortical source distribution of the OFF ASSR using a melody tracking task, in which attention was directed between uniquely amplitude-modulated melody streams that differed in pitch. The ON and OFF ASSRs were recorded with magnetoencephalography (MEG) on a group of participants varying from low to high degree of musical sophistication. Our results show that the OFF ASSR is different from the ON ASSR in nearly every aspect. While the ON ASSR was modulated by the stimulus properties and selective attention, the OFF ASSR was not influenced by any of these factors. Furthermore, while the ON ASSR was generated primarily from temporal sources, the OFF ASSR originated mainly from the frontal cortex. These findings challenge the notion that the OFF ASSR is merely a continuation of the ON ASSR. Rather, they suggest that the OFF ASSR is an internally-driven signal that develops from an initial sensory processing state (ON ASSR), with both types of ASSRs clearly differing in cortical representation and character. Furthermore, our results show that the ON ASSR power was enhanced by selective attention at cortical sources within each of the bilateral frontal, temporal, parietal and insular lobes. Finally, the ON ASSR proved sensitive to musicality, demonstrating positive correlations between musical sophistication and ASSR power, as well as with the degree of attentional ASSR modulation at the left and right parietal cortices. Taken together, these results show new aspects of the ASSR response, and demonstrate its usefulness as an effective tool for analysing how selective attention interacts with individual abilities in music perception.

GJB2 mutation spectrum in the Taiwanese population and genotype-phenotype comparisons in patients with hearing loss carrying GJB2 c.109G>A and c.235delC mutations

Hearing loss, the most common sensory abnormality, is caused by the death of or damage to inner ear hair cells. Genetic mutations are the main cause of hearing loss. We used nex-generation sequencing data released by the Taiwan Biobank to investigate the GJB2 mutation spectrum in 1517 patients. We compared hearing function in Taiwanese patients with nonsyndromic hearing loss (NSHL) caused by the two most common GJB2 mutations c.109G>A (p.V37I) and c.235delC. We extracted DNA from the oral mucosa of patients with NSHL and performed Sanger sequencing to confirm the genotype. Of 240 patients with NSHL, we identified 25 with GJB2 c.109G>A and 9 with GJB2 c.235delC mutations, after excluding patients aged >10 years, in whom hearing loss may have been caused due to age-related degeneration. We investigated genotype-phenotype correlations in patients harboring GJB2 c.109G>A and c.235delC mutations. Furthermore, we described the GJB2 mutation spectrum in the Taiwanese population and identified the role of homozygous and heterozygous GJB2 mutations associated with hearing phenotypes in patients with NSHL. Thus, our study provides insights into the complexity of GJB2 genetics. Our data indicate that GJB2 c.109G>A heterozygotes had poorer hearing than did homozygotes. The mechanism underlying the more severe phenotype in heterozygotes and whether the phenotype is caused by GJB2 heterozygotes or compound heterozygotes warrant future investigation.

Hearing loss in very preterm infants: should we wait or treat?

This study investigated hearing threshold changes during the first year of corrected age (CA) in infants admitted in a neonatal intensive care unit (NICU). In 5 years, 239 infants with birth weight (BW) ≤ 1,000 gm and/or gestational age (GA) ≤ 30 weeks were enrolled. Hearing was evaluated by oto-acoustic emission (OAEs) before discharge and auditory brainstem response (ABR) within 3 months of CA. Infants affected by unilateral or bilateral hearing loss were addressed to audiological follow-up until definitive diagnosis (within 6 months of CA). Changes in hearing threshold were also carefully analysed. 207 (86.6%) infants had normal hearing while 32 infants (13.4%) showed hearing loss (HL) at the confirmative ABR evaluation (9 mild, 16 moderate, 4 severe, 3 profound). The latter showed lower GA (27.7 ± 2 vs 28.4 ± 1.2; p = 0.0061) and BW (950 ± 390 vs 1,119 ± 326 gm; p = 0.0085). At final evaluation, 15 infants (47%) recovered a normal hearing. HL was confirmed in 17 patients. Among these, 3 infants were addressed to audiological follow-up (one case of mild unilateral hearing loss (UHL) and two with moderate UHL), while in 14 cases (44%) with bilateral sensory neural hearing loss (SNHL) (7 moderate, 4 severe, 3 profound) hearing aids were prescribed. They showed significantly lower GA and longer hospital stay in the NICU in comparison with infants without indication for audiological habilitation (18 infants) (GA 26.2 ± 2.2 weeks vs 28.4 ± 2.4; p = 0.01; NICU stay 132 ± 67 vs 59 ± 7; p = 0.0002). Definitive diagnosis was obtained at 5.9 ± 1.3 months of CA. Our study confirms the importance of audiological surveillance in preterm newborns. Hearing thresholds of preterm infants with hearing loss can change during the first year of CA and we observed normalisation in 47% of our patients. Most vulnerable to permanent SNHL were very preterm infants with a longer NICU stay, while a shorter stay represents a favourable prognostic factor for hearing improvement.

The value of ABR- and ASSR-based hearing estimation in young children with congenital monaural malformation (atresia)

Background: The electrophysiology of auditory nerve mature is particularly important for unilateral hearing loss. Objectives: To assess the hearing status in young children with congenital monaural malformation and evaluate their potential for practical use in the functional maturation parameters of the auditory pathway. Materials and methods: ABR (auditory brainstem responses) and ASSR (auditory steady-state responses) threshold measurements were performed in 21 young children with congenital monaural atresia. Results: The average electrophysiologic thresholds for the ABR were 65 dB nHL ± 1.20 in malformed ears and 25 dB nHL ± 0.48 in normal ones. All 21 atretic ears presented with typical conductive hearing loss. There was no statistic positive correlation in hearing-impaired ears between the methods of ABR and ASSR responses (r = 0.12, 0.20 and 0.17). The IPL (interpeak latency) of I-III, III-V and I-V of atretic ears in ABR test was decreased relative to normal ears. Furthermore, a shortening of the IPLs I-III, III-V, I-V can be observed with increasing age of the children in malformed ears. Conclusions and significance: The ABR- and ASSR-based hearing evaluation in young children with congenital monaural malformation should be viewed as complementary technologies. Besides, there was no delay of functional maturation at brainstem level although unilateral hearing was deprived during their early years of life.

Validity of correction factors applied to auditory steady-state responses (ASSRs) in normal hearing adults in chartr EP system

OBJECTIVES

Even though many patients undergoing auditory steady-state response (ASSR) testing have some degree of hearing loss, some have normal hearing and ASSR often overestimates the behavioral thresholds in this group. In most commercial ASSR systems such as Chartr EP, a default correction factor is applied to compensate for this difference. Little is known, however, as how the correction factor compensates for the difference between ASSR and pure tone audiometry (PTA) thresholds as a function of carrier or modulation frequency (MF) in a commercial ASSR system. Our goal is to evaluate this relationship.

METHODS

Twenty-four normal hearing adults were examined for both PTA and ASSR (Chartr EP system, GN Otometrics). ASSR thresholds were obtained at three MFs (20, 40, and 80 Hz). The difference scores were obtained by subtracting PTA from ASSR thresholds at each frequency for each subject. The corrected ASSR thresholds, then, were compared with the PTA thresholds across MFs and carrier frequencies.

RESULTS

The default correction factors in the ASSR equipment differed significantly from the difference scores at all MFs and carrier frequencies (n = 24, p < 0.005). The correlation between corrected ASSR and PTA thresholds at most MFs and carrier frequencies were medium to poor.

CONCLUSIONS

At most MFs and carrier frequencies, the default correction factors defined by the manufacturer do not compensate for the difference between ASSR and PTA thresholds in normal hearing adults. The use of the default correction factors in Chartr EP system for the normal hearing adults needs special considerations.

Benefit of hearing aid use in the elderly: the impact of age, cognition and hearing impairment

This study describes the benefits of hearing aid (HA) use in a sample of elderly experienced HA users (n = 102, mean age 81.1 years), investigating the role of the age, hearing impairment and cognitive function. The benefit was assessed in aided condition by measuring audiometric outcomes (aided thresholds and speech reception in quiet and in noise) and self-assessed outcomes addressing the disability and the handicap domains of auditory dysfunction. Several cognitive abilities were assessed, including short-term memory, working memory and executive functions. To discover potential latent factors and assess which factors significantly influenced the benefit of HA use, age, hearing impairment, cognitive function, audiometric and self-assessed outcomes were examined with multivariate analysis, followed by correlation and regression analysis. The analysis revealed a significant improvement in aided audiometric outcomes and a decrease in the perceived disability and handicap in the sample population. Multivariate, correlation and regression analyses showed that better aided audiometric outcomes were significantly associated with hearing impairment of lower degree and higher cognitive abilities. Moreover, self-assessed outcomes were significantly associated with audiometric outcomes and hearing impairment: subjects with better audiometric outcomes and lower hearing impairment tend to perceive more benefit in using their HAs. Cognition was only indirectly associated with self-assessed outcomes through its direct correlation with aided audiometric outcomes, meaning that the perceived subjective benefit with HA was not directly associated with better cognitive abilities.