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Optimizing Parameters for Using the Parallel Auditory Brainstem Response to Quickly Estimate Hearing Thresholds
Melissa J Polonenko1,2, Ross K Maddox1,2,3
1Department of Neuroscience, Del Monte Institute for Neuroscience, University of Rochester, Rochester, New York, USA.
Insights
The parallel auditory brainstem response (pABR) offers a faster method for infant hearing assessments. Optimal parameters, including a 40 Hz stimulation rate, were identified for efficient and effective pABR use in clinical settings.
Area of Science:
- Audiology
- Neuroscience
- Pediatric Medicine
Background:
- Early hearing loss detection is crucial for intervention and developmental outcomes.
- Standard auditory brainstem response (ABR) testing can be time-consuming.
- The parallel auditory brainstem response (pABR) was developed to expedite infant hearing assessments.
Purpose of the Study:
- To determine optimal presentation rates and levels for pABR.
- To establish normative stimulus level correction values for pABR stimuli.
- To enhance the speed and effectiveness of diagnostic hearing assessments.
Main Methods:
- Recorded pABR EEG responses in 20 adults with normal hearing across six stimulation rates and two intensities.
- Analyzed wave V amplitude, latency, and time to reach a 0 dB signal-to-noise ratio.
- Measured behavioral thresholds for pure tones and pABR stimuli to derive correction factors.
Main Results:
- pABR showed adaptation with increased stimulation rate; 40 Hz was optimal.
- Robust responses were obtained in under 15 minutes.
- Correction factors for converting stimulus levels (dB peSPL to dB nHL) were established.
Conclusions:
- The optimal stimulation rate for pABR is 40 Hz, though multiple rates may be beneficial.
- Subtle changes in perceptual thresholds across rates allow for flexible threshold estimation.
- Optimized pABR parameters improve the expediency and effectiveness of hearing threshold estimation in clinical settings.
Objectives:
Timely assessments are critical to providing early intervention and better hearing and spoken language outcomes for children with hearing loss. To facilitate faster diagnostic hearing assessments in infants, the authors developed the parallel auditory brainstem response (pABR), which presents randomly timed trains of tone pips at five frequencies to each ear simultaneously. The pABR yields high-quality waveforms that are similar to the standard, single-frequency serial ABR but in a fraction of the recording time. While well-documented for standard ABRs, it is yet unknown how presentation rate and level interact to affect responses collected in parallel. Furthermore, the stimuli are yet to be calibrated to perceptual thresholds. Therefore, this study aimed to determine the optimal range of parameters for the pABR and to establish the normative stimulus level correction values for the ABR stimuli.
Design:
Two experiments were completed, each with a group of 20 adults (18-35 years old) with normal-hearing thresholds (≤20 dB HL) from 250 to 8000 Hz. First, pABR electroencephalographic (EEG) responses were recorded for six stimulation rates and two intensities. The changes in component wave V amplitude and latency were analyzed, as well as the time required for all responses to reach a criterion signal-to-noise ratio of 0 dB. Second, behavioral thresholds were measured for pure tones and for the pABR stimuli at each rate to determine the correction factors that relate the stimulus level in dB peSPL to perceptual thresholds in dB nHL.
Results:
The pABR showed some adaptation with increased stimulation rate. A wide range of rates yielded robust responses in under 15 minutes, but 40 Hz was the optimal singular presentation rate. Extending the analysis window to include later components of the response offered further time-saving advantages for the temporally broader responses to low-frequency tone pips. The perceptual thresholds to pABR stimuli changed subtly with rate, giving a relatively similar set of correction factors to convert the level of the pABR stimuli from dB peSPL to dB nHL.
Conclusions:
The optimal stimulation rate for the pABR is 40 Hz but using multiple rates may prove useful. Perceptual thresholds that subtly change across rate allow for a testing paradigm that easily transitions between rates, which may be useful for quickly estimating thresholds for different configurations of hearing loss. These optimized parameters facilitate expediency and effectiveness of the pABR to estimate hearing thresholds in a clinical setting.
