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Updated: Aug 5, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
A meta-analysis of bone conduction 80 Hz auditory steady-state response thresholds in adults and infants
Emanuele Perugia1, Constantina Georga2
1Manchester Centre for Audiology and Deafness, Division of Psychology, Communication & Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
Introduction:
Auditory steady-state responses (ASSRs) objectively estimate hearing thresholds in individuals unable to provide behavioral responses. Bone conduction (BC) testing differentiates conductive from sensorineural hearing loss. Accurate BC ASSR threshold estimation relies on correction values, which are not yet well established. The reliability of BC ASSR thresholds to estimate hearing thresholds at 500, 1,000, 2,000, and 4,000 Hz is evaluated.
Methods:
A systematic search was conducted to identify studies involving normal-hearing (NH) and hearing-impaired (HI) participants of all ages. Outcomes were (1) the difference between ASSR behavioral and ASSR thresholds, and (2) ASSR thresholds. The risk of bias was evaluated using the Newcastle-Ottawa Scale. The certainty of the evidence was assessed using GRADE approach.
Results:
Twelve records met the inclusion criteria, yielding a total of 29 studies. Sample sizes ranged from 60 to 271 participants across frequencies and age groups. Record quality ranged from low to high. Data were synthesized using random-effects models due to heterogeneity. In NH adults, the mean differences between BC ASSR thresholds and behavioral thresholds were 17.0, 15.5, 13.4, and 12.1 dB at 500, 1,000, 2,000, and 4,000 Hz, respectively. In NH infants, mean BC ASSR thresholds were 17.2, 10.5, 26.1, and 19.9 dB HL at the same frequencies. In infants with conductive HL, BC ASSR threshold was 20.3 at 500 Hz. The certainty of the evidence was very low.
Conclusions:
Age and frequency impact BC ASSR thresholds, highlighting the need to develop correction values to accurately predict BC behavioral thresholds.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023422150.
