Auditory steady-state response in children with cochlear hearing loss

The Auditory Steady-State Response and the Relationship between Electrophysiological and Behavioural Thresholds

BACKGROUND

This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss.

MATERIALS AND METHODS

After being assessed, 45 children of both sexes, ranging in age from 5 to 15, were split into four groups: 10 with moderate to moderately severe sensorineural hearing loss (G2M); 10 with steeply sloping sensorineural hearing loss (G2D); 10 with profound and severe sensorineural hearing loss (G2S); and 15 with normal hearing (G1). ASSR, tympanometry, acoustic reflex testing, pure tone audiometry, and speech audiometry (SRT and SDT) were performed.

RESULTS

The electrophysiological maximum in the group with normal hearing thresholds varied from 19 to 27 dB NA. The correlation in the group with moderate to moderately severe hearing loss was 0.42-0.74. The correlation in the steeply sloping hearing loss group was 0.68-0.94. The correlation in the group of people with profound and severe hearing loss was 0.59-0.86. The normal hearing group's mean differences in ASSR threshold and audiometric threshold ranged from -0.3 to 12 dB, in the moderate and moderately severe hearing loss group from -9 to 2 dB, in the steeply sloping hearing loss group from 1.4 to 7.5 dB, and in the severe and profound hearing loss group from -0.40 to 8.5 dB.

CONCLUSION

As expected, there was no strong relationship between behavioural and electrophysiological thresholds in the group with normal hearing. But in children with hearing loss, there was a strong correlation between electrophysiological and behavioural thresholds; this relationship was especially evident in children with severe and profound hearing loss and those with steeply sloping hearing loss.

Potencial evocado auditivo de estado estável em crianças e adolescentes

RESUMO Introdução A aplicabilidade do potencial evocado auditivo de estado estável tem crescido no diagnóstico audiológico. Objetivo Verificar a correlação entre os limiares eletrofisiológicos obtidos no Potencial Evocado Auditivo de Estado Estável e os limiares comportamentais obtidos na audiometria tonal liminar em crianças e adolescentes com audição normal e perda auditiva neurossensorial de grau moderado a moderadamente severo. Métodos Foram avaliados 25 indivíduos de ambos os sexos com idade entre 5 e 15 anos, distribuídos nos seguintes grupos: 15 indivíduos com audição normal e 10 indivíduos com perda auditiva neurossensorial de grau moderado a moderadamente severo. Os indivíduos foram submetidos a: audiometria tonal liminar, logoaudiometria, medidas de imitância acústica (timpanometria e pesquisa dos reflexos acústicos) e ao potencial evocado auditivo de estado estável. Resultados No grupo com audição normal, os limiares eletrofisiológicos máximos situaram-se entre 19 a 27 dBcgNA. No grupo com perda auditiva de grau moderado a moderadamente severo, a correlação encontrada foi de 0,42 a 0,74. As diferenças médias do limiar eletrofisiológico e o limiar comportamental situaram-se entre: –0,3 e 12 dB para o grupo de audição normal e de –9 e 2 dB no grupo com perda auditiva de grau moderado a moderadamente severo. Conclusão No grupo com audição normal não houve correlação entre os limiares eletrofisiológicos e comportamentais, em contrapartida foi encontrada correlação positiva no grupo com perda de grau moderado a moderadamente severo.

Auditory steady-state responses in school-aged children: a pilot study

Background

The use of Auditory Steady-State Responses (ASSRs) for auditory screening in school-aged children, particularly in children who are difficult to test and children with disabilities, has not been explored yet. This pilot study investigated the use of ASSR for auditory screening in school-aged children.

Materials and methods

A cross-sectional pilot study of 23 children aged 9 to 11 with normal-hearing thresholds and seven age-matched children with permanent moderate-to-profound bilateral hearing loss were examined. The tested carrier frequencies were 500, 1,000, 2,000, and 4,000 Hz, and the stimulus was modulated between 77 and 107 Hz. The ASSRs decreased according to the tested intensity levels of 50, 40, and 30 dB sound pressure level (SPL). Sensitivity and specificity were estimated from the responses of the children with normal hearing and those with hearing loss.

Results

For the children with normal hearing, the 2,000-Hz frequency was detected more often in both ears and at all intensity levels compared to the other frequencies. The 500- and 2,000-Hz frequencies resulted in different response patterns in both ears. The time until response detection increased in parallel with amplitude reduction, as expected. The overall time required for the test was 15 minutes, including the time spent in volunteer preparation. The sensitivity was 97% for the three intensities, and the best specificity value was 100%, which was observed at 50 dB.

Discussion

The response analysis indicated that a screening protocol for school-aged children could include 1,000, 2,000, and 4,000 Hz and that the recording of ASSRs was highly sensitive to internal and external factors. Fifty dB SPL should be considered a cut-off criterion for screening purposes because this was the intensity level with a sensitivity of 97% and a specificity of 100%.

Conclusion

The use of ASSRs might be particularly useful in school-aged children who have difficulty performing subjective hearing tests. The sensitivity and specificity data suggested that the use of ASSRs was feasible as an auditory screening tool. In order to determine a protocol for screening, future studies should include a larger sample and children with mild hearing loss.

Auditory steady-state response thresholds in adults with conductive and mild to moderate sensorineural hearing loss

Background:

The Auditory steady state response (ASSR) provides a frequency-specific and automatic assessment of hearing sensitivity and is used in infants and difficult-to-test adults.

Objectives:

The aim of this study was to compare the ASSR thresholds among various types (normal, conductive, and sensorineural), degree (normal, mild, and moderate), and configuration (flat and sloping) of hearing sensitivity, and measuring the cutoff point between normal condition and hearing loss for different frequencies.

Patients and Methods:

This clinical trial was performed in Iran and included patients who were referred from Ear, Nose, and Throat Department. A total of 54 adults (27 with sensorineural hearing loss, 17 with conductive hearing losses, and 10 with normal hearing) were randomly chosen to participate in our study. The type and degree of hearing loss were determined through testing by otoscopy, tympanometry, acoustic reflex, and pure tone audiometry. Then the ASSR was tested at carrier frequencies of 500, 1000, 2000, and 4000 Hz.

Results:

The ASSR accurately estimates the behavioral thresholds as well as flat and sloping configurations. There was no correlation between types of hearing loss and difference of behavioral and ASSR thresholds (P = 0.69). The difference between ASSR and behavioral thresholds decreased as severity of hearing loss increased. The 40, 35, 30, and 35 dB could be considered as cutoffs between normal hearing and hearing loss for 500, 1000, 2000, and 4000 Hz, respectively.

Conclusions:

The ASSR can accurately predict the degree and configuration of hearing loss and discriminate the normal hearing from mild or moderate hearing loss and mild from moderate hearing loss, except for 500 Hz. The Air-conducted ASSR could not define the type of hearing loss.

Correlation of the findings of auditory steady-state evoked potential and of behavioral hearing assessment in infants with sensorineural hearing loss

PURPOSE

To correlate the findings of an open-field audiometry with the thresholds of steady-state auditory-evoked potentials (SSAEPs) found in infants of up to 6 months of age with sensorineural hearing loss.

METHODS

This study included 19 infants with sensorineural hearing loss (8 males and 11 females), with minimum age of 2 months and maximum age of 6 months. The SSAEPs were assessed at 500 and 2000 Hz, and the audiometry was performed in open field through observation of behavioral responses to sound stimuli, at the same frequencies.

RESULTS

We observed a significant correlation between the findings of both tests conducted at 500 and 2000 Hz, with p-values of 0.002 and 0.013, respectively. There was no statistical difference between ears (p=0.532) and genders (p=0.615).

CONCLUSION

We conclude that there was a significant correlation between the SSAEP thresholds and the findings of the open-field audiometry. Therefore, we can affirm that the SSAEPs are a viable examination, able to predict the degree and configuration of hearing loss in infants of up to 6 months of age, and that they can be included in the clinical routine of hearing assessments conducted in children.

Association between phenotype, performance with hearing aids, and genotype of childhood hearing loss in children with and without genetic alteration

PURPOSE

To establish the frequency of genetic mutations related to sensorineural hearing loss (SNHL); to verify if there is association between the degree of SNHL and the presence of genetic alteration; and to verify if the Minimal Response Levels (MRL) with hearing aids vary according to the genetic alteration.

METHODS

Thirty hearing aids users with ages between 8 and 111 months were evaluated. The evaluation procedures used were: pure-tone audiometry; the auditory steady state response (ASSR) on sound field, with and without hearing aids; and genetic study of the hearing loss.

RESULTS

Three genetic mutations were diagnosed: 35delG, A1555G and A827G, and the children with these mutations showed higher degree of SNHL. There was no difference between the genetic patterns regarding the degree of SNHL, except for patients with A827G mitochondrial mutation, because all subjects with this mutation had profound SNHL. The difference between the MRL obtained with and without amplification, considering the presence of mutation and the degree of SNHL, was higher in children with moderate SNHL without genetic alterations, both in behavioral and electrophysiological evaluations.

CONCLUSION

Genetic mutations were found in 36.7% of the sample, justifying the importance of genetic tracking in the hearing habilitation process. Children with genetic mutations showed higher degrees of hearing loss. The different mutation patterns do not directly determine the degree of hearing loss. The best thresholds with amplification were found in children with moderate hearing loss without genetic alterations.

Fatores determinantes no desenvolvimento de habilidades comunicativas em crianças com deficiência auditiva

OBJETIVO: Estabelecer relações entre a idade de início de utilização de aparelhos de amplificação sonora individual (AASI); audição funcional, habilidades comunicativas, envolvimento familiar e as expectativas da família em relação ao desenvolvimento de linguagem em criança com deficiência auditiva diagnosticadas nos três primeiros anos de vida. MÉTODOS: Foram avaliados 35 bebês com diagnóstico de deficiência auditiva de grau moderado a profundo, ao longo de 24 meses, em acompanhamento no Centro Audição na Criança/Derdic (CeAC). Foram realizadas avaliações semestrais incluindo: VRA - Audiometria de reforço visual (com e sem amplificação); IT-MAIS; MUSS; e satisfação da família com o desenvolvimento das crianças. RESULTADOS: foi realizada análise de agrupamentos entre os sujeitos. O uso consistente do AASI foi a única variável com forte relação com habilidades auditivas e de linguagem entre os grupos. Em comum, os sujeitos com os pais não satisfeitos possuem filhos que apresentam deficiência auditiva de grau profundo e capacidade auditiva limitada mesmo com o uso do AASI, consequentemente também as habilidades auditivas e produção de fala em padrões rebaixados. CONCLUSÃO: O acompanhamento dos recursos de datalogging pode nortear o conhecimento do fonoaudiólogo servindo de estratégia. O envolvimento familiar, a qualidade da participação dos pais no programa de intervenção assim como as expectativas em relação ao futuro são aspectos importantes a serem considerados nesses achados que podem contribuir para terapeutas e pesquisadores na avaliação da efetividade de propostas de intervenção para bebês com deficiência auditiva.