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Aided Cortical Auditory Evoked Potentials in Infants With Frequency-Specific Synthetic Speech Stimuli: Sensitivity,
Anisa S Visram1,2, Michael A Stone1,2, Suzanne C Purdy3
1Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, United Kingdom.
Insights
Cortical auditory evoked potential (CAEP) testing shows good sensitivity and feasibility for infant hearing aid users. Repeat testing significantly improves detection rates for aided audibility in infants.
Area of Science:
- Pediatric Audiology
- Neuroscience
- Hearing Science
Background:
- Infant hearing aid users often cannot undergo traditional behavioral testing.
- Cortical auditory evoked potential (CAEP) testing offers a potential solution for assessing hearing in infants.
- Further data on CAEP sensitivity, repeatability, and feasibility in infants are needed.
Purpose of the Study:
- To assess the sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants.
- To provide data on CAEP performance across different sensation levels (SLs) in the target age group.
- To evaluate CAEPs as a supplement to current clinical practices for infant hearing assessment.
Main Methods:
- 103 infant hearing aid users (3-7 months) underwent aided CAEP testing with mid-frequency (MF) and high-frequency (HF) stimuli.
- CAEP testing was repeated within 7 days.
- Behavioral testing (7-21 months) estimated stimulus sensation levels (SLs) for CAEP sessions; acceptability and feasibility were also assessed.
Main Results:
- Overall CAEP sensitivity was 70% (MF) and 54% (HF) for single tests at ≥0 dB SL, increasing to 84% (MF) and 72% (HF) with repeat testing.
- For SL >10 dB, sensitivity reached 94% (MF) and 79% (HF) with two tests.
- Feasibility was high with >99% completion rate and a median test duration of 24 minutes; caregivers reported positive experiences.
Conclusions:
- Aided CAEP testing effectively supplements clinical practice for infants not ready for behavioral assessment.
- Repeat CAEP testing is crucial for enhancing sensitivity in assessing aided audibility.
- Awareness of CAEP response variability is important for clinical application in infants.
Objectives:
The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants.
Design:
One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate.
Results:
The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test.
Conclusions:
By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group.
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