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Updated: Jul 4, 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 steady-state response and auditory brainstem response thresholds in children
DeWet Swanepoel1, Shamim Ebrahim
1Department of Communication Pathology, University of Pretoria, Pretoria 0002, South Africa. dewet.swanepoel@up.ac.za
Insights
Objective audiometry using auditory steady-state response (ASSR) reliably verifies auditory brainstem response (ABR) thresholds in infants. This comparison is crucial for diagnosing hearing loss when behavioral tests are not feasible.
Area of Science:
- Audiology
- Neuroscience
- Pediatric Medicine
Background:
- Auditory steady-state response (ASSR) is increasingly used in objective audiometry.
- Clinical comparisons between ASSR and auditory brainstem response (ABR) are essential for validating hearing assessment methods.
- Accurate hearing threshold determination in infants and young children is critical for early intervention.
Purpose of the Study:
- To compare auditory steady-state response (ASSR) and auditory brainstem response (ABR) thresholds in infants and young children.
- To evaluate the reliability of ASSR in assessing various types and degrees of hearing loss.
- To establish the correlation between ASSR and ABR thresholds for different frequency ranges.
Main Methods:
- A cohort of 48 infants and young children with diagnosed hearing loss was studied.
- Audiometric assessment included broadband click-evoked ABR and single-frequency ASSR (0.25-4 kHz).
- Subjects were classified by hearing loss type and degree; thresholds were statistically analyzed.
Main Results:
- High correlation (r=0.92) was observed between ABR and mean ASSR thresholds (2-4 kHz and 1-4 kHz).
- Mean difference scores between ABR and high-frequency ASSR thresholds were within acceptable clinical ranges.
- The 2-4 kHz ASSR average correlated best with ABR across most hearing loss categories.
Conclusions:
- Auditory steady-state response (ASSR) thresholds are reliable and can effectively cross-check auditory brainstem response (ABR) findings.
- This verification is particularly valuable for high-frequency hearing assessment in young children.
- ASSR provides a dependable objective measure for hearing loss evaluation when behavioral audiometry is not feasible.
Abstract:
The inclusion of the auditory steady-state response (ASSR) into test-batteries for objective audiometry has allowed for clinical comparisons with the most widely used procedure, the auditory brainstem response (ABR). The current study describes ASSR and ABR thresholds for a group of infants and young children with various types and degrees of hearing loss. A sample of 48 subjects (23 female) with a mean age of 2.8+/-1.9 years SD were assessed with a comprehensive test-battery and classified according to type and degree of hearing loss. Thresholds were determined with a broadband click-evoked ABR and single frequency ASSR evoked with continuous tones (0.25-4 kHz) amplitude modulated (67-95 Hz). Mean difference scores (+/-SD) between the ABR and high frequency ASSR thresholds were 9.8 (+/-11), 3.6 (+/-12) and 10.5 (+/-12) dB at 1, 2 and 4 kHz, respectively. An ASSR mean threshold for 2-4 and 1-4 kHz compared to the ABR threshold revealed an average difference of 7 (+/-9) and 7.9 (+/-8) dB, respectively. The overall correlation between the ABR and ASSR thresholds was highest for the mean ASSR thresholds of 2-4 and 1-4 kHz (r=0.92 for both conditions). Correlations between the ABR and individual ASSR frequencies were slightly less (0.82-0.86). The average of the 2-4 kHz ASSR thresholds correlated best with the click-evoked ABR for all categories of hearing loss except for the sensorineural hearing loss category for which the 1-4 kHz ASSR average was better correlated to ABR thresholds. Findings demonstrate the reliability of verifying high frequency ASSR thresholds with a click-evoked ABR as an important cross-check in infants for whom behavioural audiometry may not be possible.
