Cortical auditory evoked potential time-frequency growth functions for fully objective hearing threshold estimation

Cortical auditory evoked potential (CAEP) thresholds have been shown to correlate well with behaviourally determined hearing thresholds. Growth functions of CAEPs show promise as an alternative to single level detection for objective hearing threshold estimation; however, the accuracy and clinical relevance of this method is not well examined. In this study, we used temporal and spectral CAEP features to generate feature growth functions. Spectral features may be more robust than traditional peak-picking methods where CAEP morphology is variable, such as in children or hearing device users. Behavioural hearing thresholds were obtained and CAEPs were recorded in response to a 1 kHz puretone from twenty adults with no hearing loss. Four features, peak-to-peak amplitude, root-mean-square, peak spectral power and peak phase-locking value (PLV) were extracted from the CAEPs. Functions relating each feature with stimulus level were used to calculate objective hearing threshold estimates. We assessed the performance of each feature by calculating the difference between the objective estimate and the behaviourally-determined threshold. We compared the accuracy of the estimates using each feature and found that the peak PLV feature performed best, with a mean threshold error of 2.7 dB and standard deviation of 5.9 dB from behavioural threshold across subjects. We also examined the relation between recording time, data quality and threshold estimate errors, and found that on average for a single threshold, 12.7 minutes of recording was needed for a 95% confidence that the threshold estimate was within 20 dB of the behavioural threshold using the peak-to-peak amplitude feature, while 14 minutes is needed for the peak PLV feature. These results show that the PLV of CAEPs can be used to find a clinically relevant hearing threshold estimate. Its potential stability in differing morphology may be an advantage in testing infants or cochlear implant users.