Behavioral Pure-tone Audiometry Research Articles

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 < .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.

Auditory brainstem response to chirp stimulus in children with moderate and severe sensorineural hearing loss

BackgroundClick auditory brainstem response (ABR), is abrupt and rapid onset, have broad spectrum nonfrequency-specific response. ABR needs good neural synchrony, the greater number of neurons that fire results in a larger response amplitude. The application of chirp stimuli aims to produce a synchronized response from a large portion of hair cells in the basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling-time differences.ObjectivesThe aim of this study was to correlate between pure-tone audiometry (PTA) threshold and click and chirp-ABR thresholds in children with moderate and severe sensory neural hearing loss.Patients and methodsThis study included two groups: control group (G1), which consisted of 30 children with normal peripheral hearing and study group (G2), which consisted of 60 children with moderately severe sensorineural hearing loss (SNHL).ResultsResults showed that significant correlation between chirp and behavioral PTA and between click and behavioral PTA in normal hearing and hearing-impaired children, except in severe steeping SNHL. In steeping SNHL, there was a reduced correlation between behavioral PTA and click ABR stimuli. In addition, there was a significant correlation between narrow band-chirp at 500, 1000, and 4000 Hz and behavioral PTA in normal hearing and sensory neural hearing loss in children, otherwise in severe steeping SNHL. In this category, there was a reduced the correlation between behavioral PTA and narrow band-chirp-ABR stimuli.

Relationship between aided cortical auditory evoked responses and aided behavioral thresholds

ObjectivesThe present study aimed to determine the relationship between aided cortical auditory evoked potentials and aided behavioral thresholds. Secondary aims of the study were to investigate the relationship between age and Cortical Auditory Evoked Potentials latencies, and to analyze the relationship between the /m/, /g/ and /t/ stimuli. MethodTherefore, 20 subjects (4-8 years old) who diagnosed with moderate to severe hearing loss were included in the study. Behavioral pure-tone audiometry was performed using supra-aural earphones. After verification of the settings of hearing aid settings, aided behavioral thresholds were determined in the free field. Aided CAEPs were recorded using the HEARLab system in a sound-treated room. The /m/, /g/, and /t/ speech stimuli were applied with durations of 30, 20, and 30 ms respectively. ResultsA strong correlation was found between aided cortical auditory evoked responses at the level of 55 dB SPL and aided behavioral thresholds in the free field(r=0.86). We showed that the CAEP latencies were not correlated with the age (/m/ stimulus [r=-0.051; p=0.830], /g/ stimulus [r=-0.053; p=0.825], and /t/ stimulus [r=0.121; p=0,610]). The mean latency of the /m/ stimulus at 55 dB SPL intensity was longer than those of the /g/ and /t/ stimuli. ConclusionThe results of the present study demonstrated that the use of the cortical auditory evoked potentials is clinically useful for measuring the hearing aid benefit. The CAEP can predict the aided behavioral thresholds in children with moderate hearing loss.

Auditory brainstem-evoked response to chirp and click stimuli in children with moderate and severe sensorineural hearing loss

Background Auditory brainstem response (ABR) using click stimuli enables global objective estimation of hearing threshold. The application of chirp stimuli aims to produce synchronized response from large portion of hair cells in the basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling-time differences. Objectives The study aimed to compare the response characteristic of both clicks and chirps stimuli in children. Accordingly, we compared latency and amplitude of wave V at different intensity levels and waves I and III at high levels. Moreover, we correlate between pure-tone audiometry (PTA) threshold and each of click and chirp ABR threshold in the same groups. Patients and methods This study included two groups: the control group (G1) consisted of 30 children with normal peripheral hearing. A study group (G2) consisted of 60 children with moderate to severe sensorineural hearing loss. Results The results have shown that on using chirp stimuli wave V could be detected easier with shorter latency and larger amplitude than in click ABR. On the other hand, click stimulus was better than chirp stimulus at high-intensity levels regarding identification of waves I and III. In addition, there are significant correlations between chirp and behavioral PTA. Moreover, there are significant correlations between click and behavioral PTA in normal hearing and hearing-impaired children except at severe steeping sensorineural hearing loss.

Using click-evoked auditory brainstem response thresholds in infants to estimate the corresponding pure-tone audiometry thresholds in children referred from UNHS

ObjectiveTo examine whether behavioral pure-tone audiometry (PTA) thresholds in children can be accurately estimated from the corresponding infants' click-evoked auditory brainstem response (ABR) thresholds through a retrospective review of data from a universal newborn hearing screening (UNHS) program in Taiwan. MethodAccording to medical records from Mackay Memorial Hospital, Taipei Hospital District, 45,450 newborns received hearing screening during January 1999–December 2011. Among these newborns, 104 (82, both ears; 22, one ear; total, 186 ears) received regular follow-up and were recruited as subjects. The relationship between infant click-evoked ABR thresholds and the corresponding child PTA thresholds was determined through Pearson correlation coefficient and linear regression analyses. ResultsThe correlation coefficient between click-evoked ABR thresholds and behavioral PTA thresholds at the average of frequencies of 1–4 and 2–4 kHz was 0.76 and 0.76, respectively. Linear regression analysis showed that behavioral audiometry thresholds at the average of frequencies of 1–4 and 2–4 kHz were accurately estimated from click-evoked ABR thresholds in 57% and 58% children, respectively. ConclusionClick-evoked ABR testing is a reliable tool to cautiously estimate behavioral PTA thresholds at the average of frequencies of 1–4 and 2–4 kHz. For accurately performing hearing aid fitting and auditory rehabilitation in congenitally deaf infants, a combination of frequency-specific tone-burst ABR and click-evoked ABR should be used.

Implementation of objective audiometery among Suez Canal Authority workers

Background Verification of the hearing level in the malinger workers is a long-standing problem. Otolaryngologists and audiologists are often called upon to evaluate the auditory thresholds of workers who file claims for compensation as a result of noise-induced hearing loss. Although objective diagnostic methods tend to dominate modern medical science, behavioral pure-tone audiometry (PTA) remains the golden standard for identifying hearing threshold levels. A number of auditory-evoked potential techniques have been implemented for this purpose over the past three decades. The most widely used of these techniques has been the auditory brainstem response (ABR) and more recently another auditory-evoked potential, the auditory steady-state response (ASSR). We also used old techniques such as postauricular myogenic potential and late cortical-evoked potential P100 as an alternative technique for objective audiometry. Rationale Integration of different objective hearing tests is deficient in the literature on high-risk adult population. Objectives To implement an objective protocol for assessing hearing in adult patients and for those difficult to test by routine PTA in Suez Canal Authority. Materials and methods This study was designed as a case–control study to collect and analyze data from September 2012 to be finished on June 2014. Sixty adult patients divided into two groups: those suffering from normal hearing and those suffering from sensorineural hearing loss. All patients in this research were submitted to the following: full history taking and otologic examination; basic audiological evaluations (PTA, speech audiometry and immittacemetry); tone burst ABR recorded using 500, 1000, 2000, and 4000 Hz stimulus; and ASSR stimulus using carrier frequencies 500, 1000, 2000, and 4000 Hz; postauricular myogenic potential response using 1000 and 4000 Hz; and late cortical-evoked potential P100 using 1000, 2000, and 4000 Hz. Results In the normal hearing group, ASSR and ABR thresholds are closer to PTA thresholds than posterior auricular muscle (PAM) thresholds, the difference decrease with increasing frequency being closer at 4000 Hz than 500 Hz results. In the study group ASSR and ABR thresholds are approximated to PTA thresholds but still the ASSR thresholds are closer to PTA thresholds than ABR thresholds and PAM threshold but much higher in the case of P100. In the study group, ABR and ASSR thresholds show the best level of prediction of PTA thresholds. We found that the mean difference between all test and pure-tone thresholds had a tendency to be smaller with increasing frequency in both groups. However, the mean difference in the study group was statistically significantly lower than the control group. There are statistically significant positive correlation between PTA threshold and both ABR and ASSR threshold at all frequencies. A statistically significant correlation was found only at 1000 Hz in PAM test and a statistically significant correlation was found only at 1000 and 2000 Hz in P100 test. Conclusion ASSR is more accurate at higher frequencies, making ASSR more suitable in accessing auditory thresholds in patients with noise-induced hearing loss.

Is "no response" on diagnostic auditory brainstem response testing an indication for cochlear implantation in children?

To compare the results of a "no response" (NR) result on auditory brainstem response (ABR) testing with those of behavioral pure-tone audiometry and ultimate clinical tracking to cochlear implantation (CI). Retrospective review of pediatric patients who underwent multifrequency ABR testing in a 5 year span. Total of 1143 pediatric patients underwent ABR testing during the study period and 105 (9.2%) were identified with bilateral NR based on absent responses to both click and tone burst stimuli. For the children with NR, various clinical parameters were evaluated as these children progressed through the CI evaluation process. Children were grouped based on whether they underwent ABRs for diagnostic or for confirmatory purposes. Of the 105 children who met inclusion criteria, 94 had sufficient follow-up to be included in this analysis. Ninety-one (96.8%) of 94 children with bilateral NR ABRs were ultimately recommended for and received a CI. Three (3.2%) children were not recommended for implantation based on the presence of multiple comorbidities rather than auditory factors. None of the children (0%) had enough usable residual hearing to preclude CI. For those who had diagnostic ABRs, the average time at ABR testing was 5.4 months (SD 6.2, range 1-36) and the average time from ABR to CI was 10.78 months (SD 5.0, range 3-38). CI should tentatively be recommended for children with a bilateral NR result with multifrequency ABR, assuming confirmatory results with behavioral audiometric testing. Amplification trials, counseling, and auditory-based intervention therapy should commence but not delay surgical intervention, as it does not appear to change the eventual clinical course. Children not appropriate for this "fast-tracking" to implantation might include those with significant comorbidities, auditory neuropathy spectrum disorder, and unreliable or poorly correlated results on behavioral audiometric testing.

Auditory steady-state response audiometry in children with severe to profound sensorineural hearing loss

Objective The aim of the study was to find out the predictive value of single monotic auditory steady-state response (ASSR) for hearing threshold estimation in children with severe to profound sensorineural hearing loss (SNHL). Methodology Forty-eight children (96 ears) with severe to profound SNHL were included in the present study, with age range 1-10 years. They were subjected to age-based audiological evaluation to estimate the behavioral thresholds. Single monotic ASSR was performed for all children using test signals of 250, 500, 1000, 2000, and 4000 Hz, modulated in both ears at high rates of 67, 74, 81, 88, and 95 Hz, respectively, using GSI Audera-evoked potential system. ASSR thresholds were obtained and analyzed according to the equipment default criteria. Results The number and percentage of ASSR detected were highest at 1000 Hz then 500 Hz followed by 2000 Hz and were the least at 4000 and 250 Hz in all children. The ASSR thresholds obtained were statistically correlated with the behavioral pure tone audiometry thresholds at 500, 100, and 2000 Hz. A considerable number of ears with no sound field thresholds or click auditory brainstem response responses showed ASSR. Conclusion Single monotic ASSR, with high modulation frequencies, has proven to be a reasonable method for estimating hearing sensitivity in the mid-conventional audiometric frequencies in children with severe to profound SNHL. Recommendations All children with no behavioral hearing threshold and/or absent click-evoked auditory brainstem response should be tested by ASSR at 500, 1000, and 2000 Hz to give information about the presence of useful residual hearing. ASSR can provide important information for use in the cochlear implant selection process

Auditory steady-state responses for children with severe to profound hearing loss.

To investigate the clinical usefulness of the dichotic single-frequency auditory steady-state response (ASSR) for estimation of behavioral thresholds in children with severe to profound congenital sensorineural hearing loss. A comparative experimental research design was selected to compare behavioral and ASSR thresholds for the sample. Behavioral pure-tone audiometry served as the criterion standard. Hearing Clinic, Department of Communication Pathology, University of Pretoria, Pretoria, South Africa. A referred sample of 10 patients (20 ears), 5 girls and 5 boys aged 10 to 15 years (mean age, 13 years 4 months), with severe to profound sensorineural hearing impairment. The difference, and correlation, between 160 pure-tone behavioral and ASSR thresholds at 0.5, 1, 2, and 4 kHz. Mean differences between ASSR and behavioral thresholds were 6 dB for 0.5 kHz and 4 dB for 1, 2, and 4 kHz, with standard deviations varying between 8 and 12 dB. No significant differences (P<.05) were observed between ASSR and behavioral thresholds, except at 0.5 kHz, and Pearson correlation coefficients varied between 0.58 and 0.74 across the evaluated frequencies, with best correlation at 1 kHz and worst at 0.5 kHz. The ASSR thresholds provided reliable estimations of behavioral thresholds for children with severe to profound hearing loss and indicated an increased sensitivity for more profound hearing loss.

Auditory neuropathy in Friedreich ataxia: A report of two cases

Friedreich ataxia (FA) is a hereditary neurodegenerative disease with autosomical recessive inheritance. The purpose of this paper is to present two cases of FA with auditory neuropathy, demonstrated by Otoacoustic emissions (OAE) and brainstem auditory evoked potentials (BAEP). The patients were two adolescent girls. Both patients underwent behavioral pure-tone audiometry, BAEP, OAE, motor nerve conduction measurement, and magnetic resonance image studies. Both girls showed at least five of nine clinical criteria for FA. They also showed abnormal BAEP and normal OAE indicating auditory neuropathy. One patient showed normal thresholds on behavioral pure-tone audiometry, whereas the other patient showed a mild sensorineural hearing loss. In one case there was absence of peripheral caloric vestibular response, and electronystagmographic abnormalities compatible with cerebellar dysfunction. Cochlear function as assessed by OAE had not been reported previously in cases of FA. We conclude that auditory neuropathy should be considered in patients diagnosed as FA. Furthermore, BAEP and OAE should be included in the diagnostic routine in these patients.

Velopharyngeal Sphincter Physiology in Deaf Individuals

Fifty-three deaf subjects with a history of prelingual profound bilateral sensorineural hearing loss, similar language habilitation with hearing aids, and normal velopharyngeal structures underwent a study protocol including speech evaluation, behavioral pure-tone audiometry, videonasopharyngoscopy, multiview videofluoroscopy, and electromyography of the velopharyngeal muscles. Subjects were divided into two groups: the first group included 13 subjects with normal nasal resonance or mild hypernasality (four normals and nine with mild hypernasality); the second group had subjects with severe hypernasality and severe articulation deficits. Pure-tone thresholds, velopharyngeal closure patterns, and electromyographic activity of velopharyngeal muscles were similar for both groups of subjects. However, in subjects with severe hypernasality, despite normal muscle activity as observed by electromyography, velopharyngeal valving activity lacked rhythm and strength during speech. It is concluded that deaf subjects may present a functional disorder of the velopharyngeal sphincter related to absence of auditory regulation during phonation. Visual biofeedback using videonasopharyngoscopy may be useful for treating this disorder.

Velopharyngeal Sphincter Physiology in Deaf Individuals

Fifty-three deaf subjects with a history of prelingual profound bilateral sensorineural hearing loss, similar language habilitation with hearing aids, and normal velopharyngeal structures underwent a study protocol including speech evaluation, behavioral pure-tone audiometry, videonasopharyngoscopy, multiview videofluoroscopy, and electromyography of the velopharyngeal muscles. Subjects were divided into two groups: the first group included 13 subjects with normal nasal resonance or mild hypernasality (four normals and nine with mild hypernasality); the second group had subjects with severe hypernasality and severe articulation deficits. Pure-tone thresholds, velopharyngeal closure patterns, and electromyographic activity of velopharyngeal muscles were similar for both groups of subjects. However, in subjects with severe hypernasality, despite normal muscle activity as observed by electromyography, velopharyngeal valving activity lacked rhythm and strength during speech. It is concluded that deaf subjects may present a functional disorder of the velopharyngeal sphincter related to absence of auditory regulation during phonation. Visual biofeedback using videonasopharyngoscopy may be useful for treating this disorder.

Interaural Attenuation Using Etymotic ER-3A Insert Earphones in Auditory Brain Stem Response Testing

Click interaural attenuation (IA) was measured behaviorally and with the auditory brain stem response (ABR) in two unilaterally deaf adults with Etymotic ER-3A insert earphones, and TDH-39P and TDH-49P supraaural earphones. Stimulus crossover for each set of earphones was also determined with pure-tone audiometry. Pure-tone results agreed with previous research, showing that the ER-3A provided substantially greater IA than the supraaural earphones, particularly for low frequencies. For click stimuli, behavioral and ABR results revealed only modest, if any, improvement in IA with the ER-3A relative to the supraaural earphones. The results of this study suggest that while the ER-3A earphones provide a clear IA advantage for behavioral pure-tone audiometry, they do not eliminate the need for contralateral masking of click stimuli in ABR testing.