Multiple auditory steady-state response thresholds to bone-conduction stimuli in young infants with normal hearing.

OBJECTIVE Multiple auditory steady-state responses (ASSRs) probably will be incorporated into the diagnostic test battery for estimating hearing thresholds in young infants in the near future. Limiting this, however, is the fact that there are no published bone-conduction ASSR threshold data for infants with normal or impaired hearing. The objective of this study was to investigate bone-conduction ASSR thresholds in infants from a Neonatal Intensive Care Unit (NICU) and in young infants with normal hearing and to compare these with adult ASSR thresholds. DESIGN ASSR thresholds to multiple bone-conduction stimuli (carrier frequencies: 500 to 4000 Hz; 77 to 101-Hz modulation rates; amplitude/frequency modulated; single-polarity stimulus) were obtained in two infant groups [N = 29 preterm (32 to 43 wk PCA), tested in NICU; N = 14 postterm (0 to 8 mo), tested in sound booth]. All infants had passed a hearing screening test. ASSR thresholds, amplitudes, and phase delays for preterm and postterm infants were compared with previously collected adult data. RESULTS Mean (+/-1 SD) ASSR thresholds were 16 (11), 16 (10), 37 (10), and 33 (13) dB HL for the preterm infants and 14 (13), 2 (7), 26 (6), and 22 (8) dB HL for the postterm infants at 500, 1000, 2000, and 4000 Hz, respectively. Both infant groups had significantly better thresholds for 500 and 1000 Hz compared with 2000 and 4000 Hz, in contrast to adults who have similar thresholds across frequency (22, 26, 18, and 18 dB HL). When 500- and 1000-Hz thresholds were pooled, pre- and postterm infants had better low-frequency thresholds than adults. When 2000- and 4000-Hz thresholds were pooled, pre- and postterm infants had poorer thresholds than adults. ASSR amplitudes were significantly larger for low frequencies compared with high frequencies for both infant groups, in contrast to adults, who show little difference across frequency. ASSR phase delays were later for lower frequencies compared with higher frequencies for infants and adults, except for 500 Hz in the preterm group. ASSR phase delays were later for infants compared with adults across frequency. CONCLUSIONS Infant bone-conduction ASSR thresholds are very different from those of adults. Overall, these results indicate that low-frequency bone-conduction thresholds worsen and high-frequency bone-conduction thresholds improve with maturation. Bone-conduction ASSR threshold differences between the postterm infants and adults probably are due to skull maturation. Differences between preterm and older infants may be explained both by skull changes and a masking effect of high ambient noise levels in the NICU (and possibly to other issues due to prematurity).

[1]  D. Stapells,et al.  Multiple auditory steady-state responses to bone-conduction stimuli in adults with normal hearing. , 2005, Journal of the American Academy of Audiology.

[2]  John J. Foxe,et al.  Normal infant and adult auditory brainstem responses to bone-conducted tones. , 1993, Audiology : official organ of the International Society of Audiology.

[3]  D. Stapells,et al.  Frequency specificity of the auditory brain stem response to bone-conducted tones in infants and adults. , 1992, Ear and hearing.

[4]  J. Nadol,et al.  Postnatal Growth of the Human Temporal Bone , 1986, The Annals of otology, rhinology, and laryngology.

[5]  W Melnick,et al.  American National Standard specifications for audiometers. , 1971, ASHA.

[6]  T. Picton,et al.  Human auditory steady-state responses to amplitude-modulated tones: phase and latency measurements , 2000, Hearing Research.

[7]  Perinatal Maturation of the Auditory Brain Stem Response: Changes in Path Length and Conduction Velocity , 1996, Ear and hearing.

[8]  M. Scherg,et al.  Intracerebral Sources of Human Auditory Steady-State Responses , 2004, Brain Topography.

[9]  B. Cone-Wesson,et al.  Hearing sensitivity in newborns estimated from ABRs to bone-conducted sounds. , 1997, Journal of the American Academy of Audiology.

[10]  Terence W. Picton,et al.  Frequency‐Specific Audiometry Using Steady‐State Responses , 1996, Ear and hearing.

[11]  K A Shaffer,et al.  THE TEMPORAL BONE: Contemporary Diagnostic Dilemmas , 1998 .

[12]  Doris-Eva Bamiou,et al.  GIN (Gaps-In-Noise) Test Performance in Subjects with Confirmed Central Auditory Nervous System Involvement , 2005, Ear and hearing.

[13]  Welfare Agencies,et al.  Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. , 2000, American journal of audiology.

[14]  Haim Sohmer,et al.  Bone conduction experiments in animals – evidence for a non-osseous mechanism , 2000, Hearing Research.

[15]  Terence W Picton,et al.  Weighted averaging of steady-state responses , 2001, Clinical Neurophysiology.

[16]  Terence W Picton,et al.  Estimating the audiogram using multiple auditory steady-state responses. , 2002, Journal of the American Academy of Audiology.

[17]  R. Ruben,et al.  Auditory Brain Stem Responses to Bone-Conducted Tones in Infants , 1989, The Annals of otology, rhinology, and laryngology.

[18]  A. Small,et al.  Current Status of the Auditory Steady-State Responses for Estimating an Infant's Audiogram , 2008 .

[19]  Susan A Small,et al.  Artifactual Responses When Recording Auditory Steady-State Responses , 2004, Ear and hearing.

[20]  James W. Hall,et al.  High-Resolution CT Scanning and Auditory Brain Stem Response in Congenital Aural Atresia: Patient Selection and Surgical Correlation , 1985, Otolaryngology Head & Neck Surgery.

[21]  G. Savio,et al.  The Low and High Frequency Auditory Steady State Responses Mature at Different Rates , 2001, Audiology and Neurotology.

[22]  G M Clark,et al.  A comparison of steady-state evoked potentials to modulated tones in awake and sleeping humans. , 1991, The Journal of the Acoustical Society of America.

[23]  G. Thompson,et al.  Visual reinforcement of head-turn responses in infants under 12 months of age. , 1977, The Journal of speech and hearing disorders.

[24]  B. Cone-Wesson,et al.  The auditory steady-state response: clinical observations and applications in infants and children. , 2002, Journal of the American Academy of Audiology.

[25]  M. S. John,et al.  MASTER: a Windows program for recording multiple auditory steady-state responses , 2000, Comput. Methods Programs Biomed..