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Updated: Jul 11, 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
Short report: establishing normal hearing for infants with the auditory steady-state response
De Wet Swanepoel1, Karen Steyn
1Department of Communication Pathology, University of Pretoria, South Africa, Pretoria. dewet.swanepoel@up.ac.za
Insights
The Auditory Steady-State Response (ASSR) technique shows normal infant hearing thresholds between 30-37 dB HL. However, these results overlap with mild hearing loss, requiring caution in interpretation.
Area of Science:
- Audiology
- Neuroscience
- Pediatrics
Background:
- Accurate hearing assessment in infants is crucial for early intervention.
- The dichotic multiple frequency Auditory Steady-State Response (ASSR) technique is used for hearing evaluation.
- Differentiating normal hearing from mild hearing loss in infants can be challenging.
Purpose of the Study:
- To characterize normal hearing thresholds in infants using the dichotic multiple frequency ASSR technique.
- To describe the range and distribution of ASSR thresholds in a cohort of young infants.
Main Methods:
- A descriptive research design was employed.
- Ten normal-hearing infants (3 male, 2 female), aged 3-8 weeks, participated.
- Otoacoustic emissions (DPOAE) and absence of hearing loss risk factors confirmed normal hearing.
Main Results:
- Mean ASSR thresholds at 0.5, 1, 2, and 4 kHz ranged from 30 to 37 dB HL (+/- 8-11 dB).
- ASSR thresholds were distributed as follows: 18% at 20 dB, 45% at 30 dB, and 38% at 40-50 dB HL.
- Recorded ASSR thresholds for normal-hearing infants fell within the mild to moderate hearing loss range.
Conclusions:
- Dichotic multiple frequency ASSR thresholds in normal-hearing infants can overlap with mild hearing loss ranges.
- Caution is advised when interpreting ASSR thresholds below 60 dB HL in young infants.
- Auditory Brainstem Response (ABR) may be necessary for cross-checking results and accurate diagnosis.
Abstract:
This study investigated the use of the dichotic multiple frequency ASSR technique for characterising normal hearing in a group of infants. A descriptive research design was implemented to describe ASSR thresholds obtained in 10 normal hearing infant ears (3 male, 2 female participants) between the age of 3 and 8 weeks. Normal hearing was controlled for by conducting a DPOAE screening test on all ears and ensuring no risk factors for hearing loss were present. Results indicated mean ASSR thresholds at 0.5, 1, 2, and 4 kHz to vary between 30 and 37 dB, +/- 8 - 11 dB within a range of 20 - 50 dB HL. Eighteen percent of ASSR thresholds were obtained at 20 dB, 45% were obtained at 30 dB, and 38% were obtained at elevated levels of 40 and 50 dB. The recorded dichotic multiple frequency ASSR thresholds for infants with normal hearing were within the mild to moderate hearing loss range which makes differentiating between less severe degrees of hearing loss and normal hearing difficult. Until future research has been conducted, caution must be practiced when interpreting ASSR thresholds below 60 dB in young infants and additional techniques such as the ABR must be used to cross-check results.
