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. 2018 Aug;38(4):361-368.
doi: 10.14639/0392-100X-1463.

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

C Aimoni  1 , L Crema  1 , S Savini  1 , L Negossi  1 , M Rosignoli  1 , L Sacchetto  1 , C Bianchini  1 , A Ciorba  1
Affiliations

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

C Aimoni et al. Acta Otorhinolaryngol Ital. 2018 Aug.

Abstract
in English, Italian

Hearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child's mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz).

Stima di soglia mediante potenziali evocati uditivi di stato stazionario in età pediatrica.

Riassunto: Effettuare una stima di soglia in età pediatrica è compito spesso difficile e complesso. A tal proposito, i potenziali evocati uditivi del tronco (ABR) rappresentano ancora la tecnica più affidabile per la definizione di soglia, sebbene il ruolo dei potenziali evocati uditivi di stato stazionario (ASSR) sia stato rivalutato negli ultimi anni. In questo studio retrospettivo sono stati valutati 42 bambini, di età compresa tra 3 e 189 mesi, per un totale di 83 orecchie. Tutti i pazienti inclusi sono risultati affetti da ipoacusia neurosensoriale (≥ 40 dB HL in base alla valutazione click-ABR). Tutti i pazienti sono stati sottoposti ad ABR, ASSR ed audiometria tonale, quest’ultima eseguita appena lo sviluppo psico-fisico del bambino lo ha consentito. I soggetti sono stati suddivisi in due gruppi: gruppo A e B, quest’ultimo ha effettuato tutte le indagini audiologiche quasi nello stesso momento, in quanto i bambini erano più grandi rispetto ai soggetti del gruppo A (in particolare sia le valutazioni elettrofisiologiche che l’audiometria tonale sono state eseguite quasi contemporaneamente). Non sono risultate differenze significative tra i livelli di soglia individuati, alle frequenze testate (0,25, 0,5, 1, 2 e 4 kHz), mediante audiometria tonale, ABR e ASSR, tra i due gruppi (test di U Mann Whitney, p < 0,05 ). Inoltre, considerando i bambini del gruppo A, non si è rilevata alcuna differenza significativa tra le soglie identificate mediante ASSR e ABR rilevate quando i bambini erano molto piccoli, e le soglie di audiometria tonale identificate successivamente. Nella nostra esperienza quindi, i potenziali evocati uditivi di stato stazionario possono essere considerati una metodica efficace ed affidabile soprattutto nella stima di soglia dei bambini molto piccoli e per le basse frequenze (compreso 0.5 kHz).

Keywords: ABR; ASSR; Audiometry; Children; Sensorineural hearing loss.

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Figures

Fig. 1.
Fig. 1.
Groups A and B, showed overall overlapping threshold profiles using pure tone audiometry and ASSR; the average time-interval between audiological tests was 22.41 months for subjects in group A and 4.37 months for group B.
Fig. 2.
Fig. 2.
Degree of correlation between threshold levels, obtained at 0.5 and 4 kHz, by PTA and ASSR, as well as those obtained by ABR and by ASSR, applying Pearson’s test for both groups (ABR threshold was obtained using a broadband click).
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