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Long-term audiometric follow-up of click-evoked auditory brainstem response in hearing-impaired infants
R Schoonhoven1, P J Lamoré, J A de Laat
1Department of ENT/Audiology, Leiden University Medical Centre, The Netherlands.
Insights
Auditory brainstem response (ABR) testing in infants can predict later hearing thresholds, but accuracy decreases with severe hearing loss. Otitis media can also impact ABR test reliability.
Area of Science:
- Audiology
- Pediatric audiology
- Neuroscience
Background:
- Early identification of hearing impairment in infants is crucial for development.
- Auditory brainstem response (ABR) provides objective hearing assessment in young children.
- Predicting later behavioral hearing thresholds from early ABR measures is essential for effective intervention.
Purpose of the Study:
- To evaluate the prognostic value of auditory brainstem response (ABR) peak V thresholds for predicting later pure-tone behavioral thresholds in infants with sensorineural hearing impairment.
- To determine the correlation between ABR and behavioral thresholds across different frequencies.
- To assess the impact of hearing impairment severity and middle ear conditions on prediction accuracy.
Main Methods:
- Collected ABR peak V thresholds using click stimuli in 163 infants (1-3 years old) with sensorineural hearing impairment.
- Obtained conventional pure-tone thresholds at octave frequencies (125-8,000 Hz) between 4 and 8 years of age.
- Analyzed the correlation between ABR and behavioral thresholds and developed predictive audiograms.
Main Results:
- Correlation between ABR and behavioral thresholds was strongest in the 1,000- to 8,000-Hz range.
- Predicted pure-tone audiograms showed standard deviations of 15-18 dB in the 500- to 4,000-Hz range.
- Pure-tone thresholds were up to 20 dB worse than ABR thresholds in the 1,000- to 8,000-Hz range for subjects with sensorineural hearing loss, indicating reduced temporal integration.
- ABR thresholds above 80 dB nHL had limited predictive value for residual hearing.
- Otitis media during ABR testing increased estimation errors to over 25 dB (SD).
Conclusions:
- ABR thresholds are valuable predictors of later behavioral hearing thresholds in infants, particularly at higher frequencies.
- The predictive accuracy is influenced by the degree of hearing impairment, with reduced reliability for severe losses.
- Presence of otitis media can significantly affect the accuracy of ABR-based hearing threshold predictions.
Abstract:
Conventional pure-tone thresholds were collected as determined at ages between 4 and 8 years from a group of 163 infants, tested by auditory brainstem response (ABR) in the age range between 1 and 3 years old for objective hearing assessment. The subjects suffered from a variety of degrees and types of sensorineural hearing impairment. The prognostic value of the ABR peak V thresholds in response to 0.1 ms clicks with respect to the behavioural thresholds at octave frequencies from 125 to 8,000 Hz obtained later is evaluated. Correlation between ABR and behavioural thresholds is largest in the 1,000- to 8,000-Hz frequency range. Predicted pure-tone audiograms (mean and SD) were determined for each 10-dB class of ABR thresholds. SDs are in the order of 15 to 18 dB in the 500- to 4,000-Hz range and slightly higher at adjacent frequencies (i.e., somewhat larger than in comparable adult studies). Mean pure-tone thresholds in the 1,000- to 8,000-Hz frequency range are up to 20 dB worse than ABR thresholds, which is opposite to findings in normally-hearing subjects. Thus, with an increasing degree of sensorineural hearing impairment, pure-tone thresholds increase at a significantly higher rate than ABR thresholds. The observation is explained in terms of reduced temporal integration in cochlear hearing loss. ABR thresholds worse than 80 dB nHL are demonstrated to have very limited predictive value with respect to the amount of residual hearing, not only in the low- but also in the high-frequency range. The presence of otitis media during ABR testing is shown to make estimation errors increase to more than 25 dB (SD).