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Updated: Jun 2, 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
Using multi-stimulus auditory steady state response to predict hearing thresholds in high-risk infants
Yi-Fan Chou1, Peir-Rong Chen, Szu-Hui Yu
1Department of Otolaryngology, Buddhist Tzuchi General Hospital, Taipei branch, Taipei, Taiwan.
Insights
Multi-stimulus auditory steady-state responses (ASSR) accurately estimate hearing thresholds in high-risk infants. These results support using ASSR for early identification and intervention of hearing loss in infants.
Area of Science:
- Audiology
- Neonatal Medicine
- Pediatric Medicine
Background:
- Congenital hearing loss affects a significant number of high-risk infants.
- Early identification and intervention are crucial for optimal developmental outcomes.
- Accurate hearing threshold estimation in infants is challenging.
Purpose of the Study:
- To evaluate the efficacy of multi-stimulus auditory steady-state responses (ASSR) in estimating hearing thresholds in high-risk infants.
- To compare ASSR-derived thresholds with pure-tone audiometry results in later childhood.
Main Methods:
- Retrospective chart review of 216 high-risk infants across three tertiary centers.
- Auditory steady-state response thresholds were measured under sedation in infants younger than 13 months.
- Pure tone audiograms were obtained using conditioned play audiometry at 23-48 months of age.
Main Results:
- High correlations were found between ASSR thresholds and pure tone thresholds at 500, 1000, 2000, and 4000 Hz (r=0.88 to 0.97).
- The correlation strength increased with more severe hearing loss and higher frequencies.
- ASSR thresholds measured in infancy predicted later pure tone thresholds with high accuracy.
Conclusions:
- Multi-channel auditory steady-state response thresholds obtained under sedation are reliable predictors of frequency-specific hearing thresholds in high-risk infants.
- ASSR can facilitate early hearing screening and intervention planning for infants.
- This method provides valuable data for managing hearing loss in at-risk infant populations.
Abstract:
The purpose of this study was to investigate whether multi-stimulus auditory steady-state responses were capable of estimating hearing thresholds in high-risk infants. A retrospective chart review study. Three tertiary referral centers. Infants born between January 2004 and December 2006 who met the criteria for risk factors of congenital hearing loss were enrolled in the study. While under sedation, the multi-stimulus auditory steady-state response was used to determine multi-channel auditory steady-state response thresholds for high-risk infants younger than 13 months. Conditioned play audiometry was then applied to these children at 23-48 months of age to obtain pure tone audiograms. Auditory steady-state response thresholds and pure tone thresholds were then compared. A total of 249 high-risk infants were enrolled in the study. 39 infants were lost during follow-up. The remaining 216 infants completed both examinations. The Pearson correlation coefficients (r) between the ASSR levels and pure tone thresholds were 0.88, 0.94, 0.94 and 0.97 at 500, 1,000, 2,000 and 4,000 Hz, respectively. The strength of the relationship between the auditory steady-state responses and pure tone thresholds increased with more severe degrees of hearing loss and higher frequencies. We conclude that initial multichannel ASSR thresholds measured under sedation are highly correlated with pure tone thresholds obtained 2 or 3 years later. ASSR can be used to predict the frequency-specific hearing thresholds of high-risk infants and can provide information for early hearing intervention.
