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Updated: Aug 24, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Auditory sensitivity in children using the auditory steady-state response
Jill B Firszt1, Wolfgang Gaggl, Christina L Runge-Samuelson
1Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee 53226, USA. jfirszt@mcw.edu
Insights
Auditory steady-state response (ASSR) effectively measures hearing sensitivity in young children with suspected hearing loss. ASSR provides valuable data, especially for severe to profound hearing loss, aiding in cochlear implant decisions.
Area of Science:
- Audiology
- Pediatric audiology
- Electrophysiology
Background:
- Early detection of hearing loss in children is crucial for development.
- Electrophysiologic measures are vital for assessing hearing sensitivity in infants and young children.
- Auditory Brainstem Response (ABR) is a common diagnostic tool, but limitations exist for certain hearing loss ranges.
Purpose of the Study:
- To evaluate the efficacy of Auditory Steady-State Response (ASSR) in determining hearing sensitivity.
- To compare ASSR thresholds with Auditory Brainstem Response (ABR) thresholds in young children.
- To assess the utility of ASSR for identifying severe to profound hearing loss.
Main Methods:
- A within-subject design comparing ABR and ASSR thresholds.
- Included 42 children suspected of hearing loss undergoing electrophysiologic assessment.
- Measured electrophysiologic threshold responses for click ABR and ASSR stimuli (0.5, 1, 2, and 4 kHz) in both ears.
Main Results:
- 50% of participants showed severe to profound hearing loss based on ABR and ASSR.
- ASSRs were detected at higher levels than ABR in some cases where ABR showed no response.
- Significant correlations were observed between high-frequency ASSR and ABR thresholds (P<.05).
- ASSR identified interaural differences not apparent from ABR in some children.
Conclusions:
- ASSR testing offers valuable supplementary data for children with severe to profound hearing loss.
- ASSR findings can assist in ear selection for cochlear implantation in young children.
- Combining objective measures like ABR and ASSR is recommended for accurate hearing sensitivity determination in pediatric audiology, particularly for cochlear implant candidacy.
Objective:
To determine the effectiveness of auditory steady-state response (ASSR) as a measure of hearing sensitivity in young children suspect for significant hearing loss.
Design:
Within-subject comparisons of click auditory brainstem response (ABR) thresholds and ASSR thresholds.
Subjects:
The study population comprised 42 children suspect for hearing loss and subsequently referred for hearing assessment using electrophysiologic techniques.
Main Outcome Measures:
Electrophysiologic threshold responses for click ABR and ASSR stimuli (0.5, 1, 2, and 4 kHz) for right and left ears.
Results:
Based on ABR and ASSR thresholds, 50% of the subjects demonstrated significant hearing loss in the severe to profound range. In some subjects, ASSRs were present at higher stimulus levels when click ABRs were absent. Significant correlations (P<.05) were found between high-frequency ASSR and click ABR thresholds for this study sample. For some subjects, ASSR findings suggested differences between ears that were not observable from the no-response click ABR results.
Conclusions:
Auditory steady-state response testing may provide additional information for children who demonstrate hearing levels in the severe to profound range. This information may be helpful when selecting the ear for cochlear implantation for a young hearing-impaired child. Multiple objective methods, such as ABR and ASSR testing, may be needed to determine accurate hearing sensitivity for young children being considered for sensory devices, and in particular, cochlear implants.
