Abstract
Objective. To evaluate Auditory Steady-State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral tests responses. Methods. This prospective study evaluated 42 children with suspected severe-to-profound hearing loss, aged from 3 to 72 months. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dB HL with a 10 dB down-seeking procedure. ASSR and behavioral test results were compared. Results. Forty-two subjects completed both ASSR and behavioral evaluation. Eleven children (26.2%) had bilateral responses. Four (9.5%) showed unilateral responses in at least two frequencies, all confirmed by behavioral results. Overall 61 ASSR responses were obtained, most (37.7%) in 500 Hz. Mean thresholds were between 101.3 and 104.2 dB HL. Among 27 subjects with absent ASSR, fifteen had no behavioral responses. Seven subjects showed behavioral responses with absent ASSR responses. No spurious ASSR responses were observed at 100 or 110 dB HL. Conclusion. ASSR is a valuable tool to detect residual hearing. No false-positive ASSR results were observed among 42 children, but in seven cases with absent ASSR, the test underestimated residual hearing as compared to the behavioral responses.
Highlights
As universal newborn hearing screening programs are established in numerous countries, more children will be diagnosed in early childhood with some degree of hearing loss.Early detection and intervention during the critical period for language and cognitive development can improve individual performance [1].Children with severe-to-profound bilateral hearing loss are candidates for cochlear implantation (CI) and require specific audiologic evaluation prior to intervention
The procedure was a routine assessment for pediatric cochlear implantation at the Department of Otolaryngology, University of Sao Paulo School of Medicine
In a unique session using light general anesthesia with Sevoflurane, all children were examined by otomicroscopy and tympanometry followed by click auditory brainstem responses, bone conduction ABR, distortion-product otoacoustic emissions (DPOAE), and Auditory Steady-State Responses (ASSR)
Summary
As universal newborn hearing screening programs are established in numerous countries, more children will be diagnosed in early childhood with some degree of hearing loss.Early detection and intervention during the critical period for language and cognitive development can improve individual performance [1].Children with severe-to-profound bilateral hearing loss are candidates for cochlear implantation (CI) and require specific audiologic evaluation prior to intervention. As early age of indication and presence of residual hearing are important factors for postimplant speech perception and language development, this has resulted in further decrease of minimum age of surgery [2,3,4,5,6,7]. In these very young children, behavioral audiologic evaluation can be challenging, may not be obtained in children younger than 6 months, and usually does not assess each ear separately. The audiologic evaluation of pediatric cochlear implant candidates relies more and more on electrophysiological measures
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