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Updated: May 7, 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
Relationship between behavioral hearing thresholds and estimated auditory steady-state response thresholds in
Rasool Panahi1, Zahra Jafari, Sara Hasani
1Department of Audiology, School of Rehabilitation, Rehabilitation Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Insights
Neonatal hyperbilirubinemia increases infant hearing loss risk. Auditory steady-state responses (ASSRs) reliably estimate hearing thresholds in children with this history, aiding early detection and management.
Area of Science:
- Pediatrics
- Audiology
- Neonatology
Background:
- Neonatal hyperbilirubinemia, characterized by elevated serum bilirubin levels (>17 mg/dL), is a known risk factor for infant hearing impairment.
- Early identification of hearing loss in infants with hyperbilirubinemia is crucial for timely intervention and management.
Purpose of the Study:
- To investigate the correlation between pure-tone audiometry (PTA) hearing thresholds and auditory steady-state responses (ASSRs) in children with a history of neonatal hyperbilirubinemia.
- To evaluate the efficacy of 90-Hz ASSR in estimating hearing thresholds in this pediatric population.
Main Methods:
- The study included 26 children (aged 2.4-11 years) with a history of neonatal hyperbilirubinemia.
- ASSR thresholds were compared with behavioral (PTA) thresholds, considering hearing loss type and degree.
- A total of 52 ears were assessed, with 12 children exhibiting normal hearing and 14 showing sensorineural hearing loss.
Main Results:
- A high correlation (r ≥ 0.81, p < 0.01) was observed between ASSR and behavioral thresholds across all frequencies.
- The strongest correlation was found at 2,000 Hz (r = 0.88, p < 0.01).
- No significant difference (p > 0.13) was found between mean behavioral and ASSR thresholds.
Conclusions:
- 90-Hz ASSR provides reliable estimation of behavioral hearing thresholds in children with a history of neonatal hyperbilirubinemia.
- ASSR is a valuable tool for assessing hearing in children with or without sensorineural hearing loss resulting from hyperbilirubinemia.
Abstract:
Increased serum bilirubin levels during infancy increase the risk of hearing loss in infants. This study aimed to investigate the relationship between pure-tone audiometry hearing thresholds and thresholds estimated using auditory steady-state responses (ASSRs) in children with a history of neonatal hyperbilirubinemia, and to evaluate the usefulness of 90-Hz ASSR in estimating hearing thresholds in children. This study was conducted on 26 children (13 girls and 13 boys) who were aged 2.4-11 years and had a history of neonatal hyperbilirubinemia (bilirubin level >17 mg/dL). ASSR thresholds were compared with behavioral thresholds and were interpreted after considering the amount and type of hearing loss. Of the 26 children, 12 had normal hearing thresholds, and 14 had varying degrees of sensorineural hearing loss. In general, a high correlation (r ≥ 0.81, p < 0.01) was found between the ASSR and behavioral thresholds. The highest correlation was observed at 2,000 Hz (r = 0.88, p < 0.01). No significant difference was observed (p > 0.13) between mean behavioral and ASSR thresholds at 52 studied ears. The results of this study showed that 90-Hz ASSR assessments provide reliable estimates of behavioral hearing thresholds in children who have a history of neonatal hyperbilirubinemia and sensorineural hearing loss or normal hearing.
