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Updated: Jan 1, 2026
Infant Auditory Processing and Event-related Brain Oscillations
Published on: July 1, 2015
Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers
Yvonne S Sininger1, Lisa L Hunter2,3, Patricia A Roush4
1C & Y Consultants, Santa Fe, NM.
Insights
New electrophysiologic testing protocols significantly reduce infant audiology test times. These expedited methods improve confidence and speed up the fitting of amplification for infants and toddlers.
Area of Science:
- Audiology
- Pediatric audiology
- Electrophysiology
Background:
- Current infant audiology protocols lack confidence, leading to repeat testing and delayed amplification fitting.
- New technologies can enhance confidence and expedite electrophysiologic testing for infants.
- Previous studies indicate faster test times with advanced electrophysiologic techniques.
Purpose of the Study:
- To detail expedited test protocols for infant and toddler diagnostic electrophysiologic testing.
- To provide a framework for improving the efficiency of pediatric audiology assessments.
Main Methods:
- Utilizing CE-Chirp stimuli and automated auditory brainstem response (ABR) detection (FMP).
- Employing Bayesian weighting for artifact rejection and Next-Generation auditory steady-state response (ASSR) with chirp stimuli.
- Implementing streamlined protocols including preliminary impedance and otoacoustic emissions testing, starting test levels based on CE-Chirp thresholds, and automated response detection.
Main Results:
- Average test times for audiogram prediction were approximately 32 minutes for ABR and 20 minutes for ASSR.
- New technologies and protocols substantially reduce testing duration for infants and toddlers.
- Expedited protocols enhance confidence in diagnostic electrophysiologic test results.
Conclusions:
- Combining novel technologies with practical strategies significantly shortens test times for pediatric audiometric threshold prediction.
- The described protocols and strategies offer a more efficient approach to infant audiology.
- Case examples illustrate the effectiveness of these expedited testing methods.
Background:
Audiologists often lack confidence in results produced by current protocols for diagnostic electrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols which extend the time needed to complete the testing and consequently delay fitting of amplification. A recent publication (Sininger et al50) has shown how new technologies can be applied to electrophysiologic testing systems to improve confidence in results and allow faster test protocols. Average test times for complete audiogram predictions when using new technologies and protocols were found to be just over 32 minutes using auditory brainstem response (ABR) and just under 20 minutes using auditory steady-state response (ASSR) technology.
Purpose:
The purpose of this manuscript is to provide details of expedited test protocols for infant and toddler diagnostic electrophysiologic testing.
Summary:
Several new technologies and their role in test speed and confidence are described including CE-Chirp stimuli, automated detection of ABRs using a technique called F MP, Bayesian weighting which is an alternative to standard artifact rejection and Next-Generation ASSR with improved response detection and chirp stimuli. The test protocol has the following features: (1) preliminary testing includes impedance measures and otoacoustic emissions, (2) starting test levels are based on Broad-Band CE-Chirp thresholds in each ear, (3) ABRs or ASSRs are considered present based on automated detection rather than on replication of responses, (4) number of test levels is minimized, (5) ASSR generally evaluates four frequencies in each ear simultaneously with flexibility to change all test levels independently.
Conclusions:
Combining new technologies with common-sense strategies has been shown to substantially reduce test times for predicting audiometric thresholds in infants and toddlers (Sininger et al50). Details and rationales for changing test strategies and protocols are given and case examples are used to illustrate.
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