Background: The multiple auditory steady-state response (multiple ASSR) is a promising technique
for determining thresholds for infants and children. However, there are few data for
infants and young children with hearing loss where multiple-ASSR thresholds have been
compared to frequency-specific gold standard (i.e., behavioral or tone-evoked auditory
brainstem response [tone ABR]) measures.
Purpose: The study compared multiple-ASSR and tone-ABR thresholds and assessed how well “normal”
ASSR levels differentiate normal from elevated thresholds.
Research Design: Multiple-ASSR and tone-ABR results (to air-conduction stimuli) were obtained in infants
and young children with hearing loss or normal hearing.
Study Sample: 98 infants with hearing loss (53 infants provided thresholds) and 34 infants with
normal hearing.
Data Collection and Analysis: Multiple-ASSR and tone-ABR results were typically completed on the same day. Correlations
between ASSR and ABR thresholds, linear regressions, and ASSR-minus-ABR threshold
difference scores were calculated for each group (normal or hearing loss), and for
both groups combined.
Results: Multiple-ASSR thresholds (dB HL) were strongly correlated (r = .97) with tone-ABR
thresholds (dB nHL) for 500, 1000, 2000, and 4000 Hz. Mean (±1 SD) difference scores
(ASSR-minus-ABR) were 10.7 ± 9.0, 9.5 ± 9.4, 9.2 ± 9.0, and 6.3 ± 9.5 dB for 500,
1000, 2000, and 4000 Hz, respectively. The previously published “normal” ASSR levels
accurately differentiated normal from elevated thresholds. Out of 523 tests with elevated
tone-ABR thresholds, the multiple ASSR was “normal” in only 22 tests. In these 13
infants, other ASSR frequencies were elevated, and thus the infants would not have
“passed” the ASSR.
Conclusions: There are few studies of infants and young children comparing ASSR thresholds to
frequency-specific gold standard measures, especially using the multiple-ASSR technique.
The present study, comparing multiple-ASSR to tone-ABR thresholds, nearly doubles
the multiple-ASSR sample size in the literature. The results indicate that the multiple-ASSR
and tone-ABR thresholds are strongly correlated, and the “normal” multiple-ASSR levels
of 50, 45, 40, and 40 dB HL correctly classified children as having “normal” or “elevated”
thresholds. However, due to the lack of air- and bone-conduction data in infants with
different types and degrees of hearing loss, further ASSR research is needed.
Key Words
Auditory steady-state response - hearing loss - infants - tone-evoked auditory brainstem
response
