Comparative study between pure tone audiometry and auditory steady-state responses in normal hearing subjects✩✩Please cite this article as: Beck RM, Ramos BF, Grasel SS, Ramos HF, Moraes MF, Almeida ER, et al. Comparative study between pure tone audiometry and auditory steady-state responses in normal hearing subjects. Braz J Otorhinolaryngol. 2014;80:35-40

Evaluating the Reliability of 'AudiClick': A Click-Based Mobile App for Hearing Loss

Introduction

To develop and validate a click-based mobile "Audiclick" app employing click noises for hearing assessments.

Materials and Methods

This prospective comparative study compares the "AudiClick" app as a hearing screening tool to pure tone audiometry. Participants listened to sounds through wired earbud headphones that were connected to an Android or iOS device.

Results

The study involved 110 participants aged between 18 to 80 years old. All degrees of hearing loss severity corresponds to pure tone average (p < 0.01) results. The app was also found to be effective at identifying hearing loss (80-99% sensitivity, specificity, positive predictive value, and accuracy). Test-retest reliability had also shown excellent ICC scores of 0.93.

Conclusions

This study demonstrates that a mobile app using click sounds can be as efficient as pure tone audiometry for field screenings, while being more cost-effective and easier to develop.

A novel approach for estimating initial sound level for speech reception threshold test

BACKGROUND

The speech reception threshold (SRT), synonymous with the speech recognition threshold, denotes the minimum hearing level required for an individual to discern 50% of presented speech material. This threshold is measured independently in each ear with a repetitive up-down adjustment of stimulus level starting from the initial SRT value derived from pure tone thresholds (PTTs), measured via pure-tone audiometry (PTA). However, repetitive adjustments in the test contributes to increased fatigue for both patients and audiologists, compromising the reliability of the hearing tests.

OBJECTIVE

Determining the first (initial) sound level closer to the finally determined SRT value, is important to reduce the number of repetitions. The existing method to determine the initial sound level is to average the PTTs called pure tone average (PTAv).

METHODS

We propose a novel method using a machine learning approach to estimate a more optimal initial sound level for the SRT test. Specifically, a convolutional neural network with 1-dimensional filters (1D CNN) was implemented to predict a superior initial level than the conventional methods.

RESULTS

Our approach produced a reduction of 37.92% in the difference between the initial stimulus level and the final SRT value.

CONCLUSIONS

This outcome substantiates that our approach can reduce the repetitions for finding the final SRT, and, as the result, the hearing test time can be reduced.

Evaluation of the Viability of Auditory Steady State Response Testing for Detection of Pseudohypacusis in Serving Personnel of the Indian Armed Forces

The most popular objective physiologic test for detecting hearing loss that is in use today is the ABR, however it is not frequency specific. The frequency specific tool available for evaluation of hearing is ASSR. The study is aimed to assess the ability of ASSR to estimate hearing thresholds and identify the ideal modulation frequency in hearing impaired personnel. All subjects and controls were subjected to PTA to determine presence/absence of hearing loss, and the nature and configuration of the hearing loss if any. The subjects were then subjected to ASSR testing to objectively ascertain hearing thresholds. The PTA thresholds obtained and the hearing thresholds obtained by ASSR were correlated in this study. The study was carried out in 100 subjects under the age of 50 years (50 with normal hearing & 50 with impaired hearing by PTA) after obtaining informed consent. Moderate correlation was found between PTA and ASSR thresholds only in certain frequencies while in other frequencies the correlation though present, was low. This study concluded that ASSR system could be used to estimate hearing thresholds only approximately as no significant linear correlations were found between PTA thresholds and ASSR at the tested frequencies.

Comparison of Auditory Steady-State Responses With Conventional Audiometry in Older Adults

Behavioral measures, such as pure-tone audiometry (PTA), are commonly used to determine hearing thresholds, however, PTA does not always provide reliable hearing information in difficult to test individuals. Therefore, objective measures of hearing sensitivity that require little-to-no active participation from an individual are needed to facilitate the detection and treatment of hearing loss in difficult to test people. Investigation of the reliability of the auditory steady-state response (ASSR) for measuring hearing thresholds in older adults is limited. This study aimed to investigate if ASSR can be a reliable, objective measure of frequency specific hearing thresholds in older adults. Hearing thresholds were tested at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz in 50 participants aged between 60 and 85 years old, using automated PTA and ASSR. Hearing thresholds obtained from PTA and ASSR were found to be significantly correlated (p &lt; .001) in a cohort consisting of participants with normal hearing or mild hearing loss. ASSR thresholds were significantly higher as compared to PTA thresholds, but for the majority of cases the difference remained within the clinically acceptable range (15 dB). This study provides some evidence to suggest that ASSR can be a valuable tool for estimating objective frequency-specific hearing thresholds in older adults and indicate that ASSR could be useful in creating hearing treatment plans for older adults who are unable to complete behavioral PTA. Further research on older adults is required to improve the methodological features of ASSR to increase consistency and reliability, as well as minimize some of the limitations associated with this technique.

Using ASSR with narrow-band chirps to evaluate hearing in children and adults

PURPOSE

All studies concerning the reliability and threshold prediction of auditory steady-state responses (ASSR) focused on a particular group of patients. The present article evaluates the use of narrow-band, chirp-evoked ASSR for testing hearing in adults and children of all ages and with different types of hearing loss, as well as normal hearing. The aims are: to determine whether there are possible influencing factors, mainly the degree of hearing loss; and to validate the clinical value of using ASSR with chirp-stimuli.

METHODS

This is a retrospective study of 667 patients who had been diagnosed with and treated for hearing loss at our tertiary referral center. The following results were compared: ASSR to pure tone audiometry (PTA); click-ABRs to PTA; and click-ABRs to ASSR. We then calculated mean, median and standard deviation. A regression analysis was used to examine the correlation between: ASSR and click-ABRs; "estimated" audiogram and PTA; click-ABRs and PTA; and ASSR and PTA.

RESULTS

We found significant correlations at all frequencies when comparing ASSR to click-ABRs, click-ABRs to PTA, and ASSR to PTA. Concerning the degree of hearing loss, there were significant differences between the patients with normal hearing and those with moderate-to-profound hearing loss.

CONCLUSION

ASSR with narrow-band chirps are a reliable tool for estimating hearing thresholds in children and adults with all kinds of hearing loss. We have demonstrated that threshold differences between PTA and ASSR are negligible in the clinical routine. The "estimated" ASSR audiogram is a good approach for communicating ASSR results to the average user.

Characteristics of Mid-Frequency Sensorineural Hearing Loss Progression

OBJECTIVES

To characterize the progression of mid-frequency sensorineural hearing loss (MFSNHL) over time.

METHODS

A retrospective chart review spanning 2012 to 2017 was performed at a tertiary care audiology and neurotology center. Our cohort included 37 patients met the criteria for MFSNHL also known as "cookie bite hearing loss." It was defined as having a 1, 2, and 4 kHz average pure tone audiometry greater than 10 dB in intensity compared with the average threshold at 500 Hz and 8 kHz.

RESULTS

Average age at initial presentation was 11.8 years (range, 8 mo to 70 yr). Across all individuals, the average mid-frequency threshold was 47 dB, compared with 27 dB at 500 Hz and 8 kHz. Twenty-three patients (62%) had multiple audiograms with 4-year median follow up time. Average values across all frequencies (0.5, 1, 2, 4, 8 kHz) in the initial audiogram was 37 dB, compared with an average of 39 dB demonstrated on final audiogram. Of those with serial audiograms, only five patients demonstrated threshold changes of 10 dB or more. Of these five patients, only one was found to have clinical worsening of MFSNHL.

CONCLUSIONS

MFSNHL is an uncommon audiometric finding with unspecified long-term outcomes. We demonstrated that most patients (96%) with MFSNHL do not experience clinical worsening of their hearing threshold over almost 4 years of follow up. Future prospective studies aimed at collecting longer-term data are warranted to further elucidate the long-term trajectory of MFSNHL patients.

The maxillary nerve block for in-office hybrid balloon sinus dilation procedures: A preliminary study

Transitioning of rhinologic procedures from the operating room to the office setting in selected patients is a rising trend. An effective pain-control, patient-preparation protocol is essential, especially with advanced in-office rhinologic procedures such as hybrid balloon sinus dilation (BSD), in which other procedures such as ethmoidectomy, turbinate reduction, and other procedures are concomitantly performed. A regimen using oral sedation, topical tetracaine gel, topical tetracaine/epinephrine-soaked cottonoid packs, and intranasal local infiltrative anesthesia can vary significantly in effectiveness and be suboptimal at times (as determined by using treated patients as historical controls). A modification of this regimen was subsequently used, incorporating the maxillary nerve block, and qualitative differences were then assessed retrospectively between the two regimens. Twenty-five consecutive patients were retrospectively studied who underwent hybrid BSD procedures in the office setting using the maxillary nerve-block regimen modification. All patients underwent BSD of the sphenoid, frontal, and maxillary sinuses with anterior and partial posterior ethmoidectomies. Five patients also underwent septoplasty, and 18 patients underwent inferior turbinate reduction procedures. Twenty-four patients received oral sedation, and all patients received topical tetracaine/epinephrine-soaked cottonoid packs. The topical tetracaine gel was dropped after 5 patients because it was not felt to be needed anymore. No intranasal local infiltrative anesthesia was used. Several qualitative differences were observed after modifying the patient-preparation regimen incorporating the maxillary nerve block. The most important observation seen with this modification was a consistently reproducible, dense anesthesia coverage over the entire nasal cavity with good paranasal sinus coverage. This modification eliminated intranasal bleeding and swelling associated with intranasal local anesthetic injections. No complications were encountered. This preliminary study provides support for use and further evaluation of the maxillary nerve block for in-office rhinologic procedures. If the trend continues to rise in performing advanced in-office rhinologic procedures in selected patients, the maxillary nerve block may find a place in the patient-preparation protocol.

Assessment of auditory threshold using Multiple Magnitude-Squared Coherence and amplitude modulated tones monaural stimulation around 40 Hz

BACKGROUND AND OBJECTIVE

The use of objective detection techniques applied to the auditory steady-state responses (ASSRs) for the assessment of auditory thresholds has been investigated over the years. The idea consists in setting up the audiometric profile without subjective inference from patients and evaluators. The challenge encountered is to reduce the detection time of auditory thresholds reaching high correlation coefficients between the objective and the conventional thresholds, as well as reducing difference between thresholds.

METHODS

This paper evaluated the use of the Multiple Magnitude-Squared Coherence (MMSC) in Auditory Steady-State Responses (ASSRs) evoked by amplitude modulated tones around 40 Hz, attaining objective audiograms, which were, later, compared to conventional audiograms. It was proposed an analysis of the electroencephalogram signals of ten subjects, monaurally stimulated, in the intensities 15, 20, 25, 30, 40 and 50 dB SPL, for carrier frequencies of 0.5, 1, 2 and 4 kHz. After the detection protocol parameters variation, two detectors were selected according to behavioral thresholds.

RESULTS

The method of this study resulted in a Maximum detector with correlation coefficient r = 0.9262, mean difference between the objective and behavioral thresholds of 6.44 dB SPL, average detection time per ear of 49.96 min and per stimulus of 2.08 min. Meanwhile, the Fast detector presented coefficient r = 0.8401, mean difference of 6.81 dB SPL, average detection time of 28.20 min per ear and 1.18 per stimulus.

CONCLUSIONS

The results of this study indicate that the MMSC use in the auditory responses detection might provide a reliable and efficient estimation of auditory thresholds.

Intra-operative hearing monitoring methods in middle ear surgeries

Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL) is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography (ECochG), auditory brainstem response (ABR), auditory steady state response (ASSR), distortion product otoacoustic emissions (DPOAE), subjective whisper test, and optical coherence tomography (OCT). Here, we illustrate several methods used clinically by reviewing the literature.

Gender and modulation frequency effects on auditory steady state response (ASSR) thresholds

For estimating behavioral hearing thresholds, auditory steady state response (ASSR) can be reliably evoked by stimuli at low and high modulation frequencies (MFs). In this regard, little is known regarding ASSR thresholds evoked by stimuli at different MFs in female and male participants. In fact, recent data suggest that 40-Hz ASSR is influenced by estrogen level in females. Hence, the aim of the present study was to determine the effect of gender and MF on ASSR thresholds in young adults. Twenty-eight normally hearing participants (14 males and 14 females) were enrolled in this study. For each subject, ASSR thresholds were recorded with narrow-band chirps at 500, 1,000, 2,000, and 4,000 Hz carrier frequencies (CFs) and at 40 and 90 Hz MFs. Two-way mixed ANOVA (with gender and MF as the factors) revealed no significant interaction effect between factors at all CFs (p > 0.05). The gender effect was only significant at 500 Hz CF (p < 0.05). At 500 and 1,000 Hz CFs, mean ASSR thresholds were significantly lower at 40 Hz MF than at 90 Hz MF (p < 0.05). Interestingly, at 2,000 and 4,000 Hz CFs, mean ASSR thresholds were significantly lower at 90 Hz MF than at 40 Hz MF (p < 0.05). The lower ASSR thresholds in females might be due to hormonal influence. When recording ASSR thresholds at low MF, we suggest the use of gender-specific normative data so that more valid comparisons can be made, particularly at 500 Hz CF.