The value of ASSR threshold-based bilateral hearing aid fitting in children with difficult or unreliable behavioral
Petros V Vlastarakos1, Alexandra Vasileiou, Thomas P Nikolopoulos
1ENT Department, MITERA Paediatric Infirmary, 6 Erythrou Stavrou Str., Athens 15123, Greece. pevlast@hotmail.com.
Insights
Auditory steady-state response (ASSR) testing, combined with auditory brainstem response (ABR) testing, is crucial for accurate hearing aid fitting in children with difficult audiometry. This approach ensures frequency-specific amplification for better auditory development.
Area of Science:
- Audiology
- Pediatric audiology
- Hearing science
Background:
- Accurate hearing aid fitting is essential for speech development in hearing-impaired children.
- Difficult or unreliable behavioral audiometry poses challenges for pediatric hearing aid fitting.
- Current practices often involve trial periods of hearing aid use, requiring careful monitoring.
Purpose of the Study:
- To evaluate the combined contribution of auditory brainstem response (ABR) and auditory steady-state response (ASSR) testing for optimal hearing aid fitting.
- To address challenges in fitting hearing aids for children with unreliable behavioral audiometry.
Main Methods:
- Analysis of 150 infants and children undergoing hearing assessment.
- Identification of 5 cases with discrepancies between ABR and ASSR results and difficult behavioral audiometry.
- Comparison of hearing aid fitting strategies using ABR alone versus combined ABR and ASSR data.
Main Results:
- Auditory brainstem response (ABR) testing alone provides non-frequency-specific amplification.
- Auditory steady-state response (ASSR) testing provides frequency-specific data crucial for accurate fitting.
- Discrepancies between ABR and ASSR highlight the need for both measures in challenging cases.
Conclusions:
- Auditory steady-state response (ASSR) threshold-based hearing aid fitting is necessary for frequency-specific amplification.
- Combining ABR and ASSR testing improves the accuracy and validity of the hearing aid fitting process.
- This integrated approach supports appropriate auditory development and prelinguistic vocalizations in infants.
Abstract:
We conducted an analysis to assess the relative contribution of auditory brainstem response (ABR) testing and auditory steady-state response (ASSR) testing in providing appropriate hearing aid fitting in hearing-impaired children with difficult or unreliable behavioral audiometry. Of 150 infants and children who had been referred to us for hearing assessment as part of a neonatal hearing screening and cochlear implantation program, we identified 5 who exhibited significant discrepancies between click-ABR and ASSR testing results and difficult or unreliable behavioral audiometry. Hearing aid fitting in pediatric cochlear implant candidates for a trial period of 3 to 6 months is a common practice in many implant programs, but monitoring the progress of the amplified infants and providing appropriate hearing aid fitting can be challenging. If we accept the premise that we can assess the linguistic progress of amplified infants with an acceptable degree of certainty, the auditory behavior that we are monitoring presupposes appropriate bilateral hearing aid fitting. This may become very challenging in young children, or even in older children with difficult or unreliable behavioral audiometry results. This challenge can be addressed by using data from both ABR and ASSR testing. Fitting attempts that employ data from only ABR testing provide amplification that involves the range of spoken language but is not frequency-specific. Hearing aid fitting should also incorporate and take into account ASSR data because reliance on ABR testing alone might compromise the validity of the monitoring process. In conclusion, we believe that ASSR threshold-based bilateral hearing aid fitting is necessary to provide frequency-specific amplification of hearing and appropriate propulsion in the prelinguistic vocalizations of monitored infants.
