Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China.
ORL J Otorhinolaryngol Relat Spec. 2022;84(1):30-38. doi: 10.1159/000515237. Epub 2021 May 12.
Chirp auditory steady-state response (ASSR) can be used to assess frequency-specific hearing thresholds. However, its reliability has not been confirmed yet. The purpose of this proposed study is to analyze the agreement of thresholds measured by chirp-ASSR and pure tone audiometry (PTA) to investigate the value of chirp-ASSR in hearing threshold evaluation.
Participants with normal hearing (age: 18-66, 108 ears) and patients with sensorineural hearing loss (age: 22-82, 75 ears) were tested using PTA and chirp-ASSR at 0.5, 1, 2, and 4 kHz, respectively. Intraclass correlation coefficient (ICC) and Bland-Altman plot were introduced to analyze the agreement between the 2 methods.
One-hundred eight participants underwent both chirp-ASSR and PTA to estimate their thresholds. The ICCs yielded by these 2 methods are 0.757, 0.893, 0.883, and 0.921 (p < 0.001) at 0.5, 1, 2, and 4 kHz carrier frequency, respectively. However, there is a significant difference between the 2 methods at 2 kHz: the mean value of the ASSR thresholds is 5.27 dB HL higher than the value of PTA thresholds. Additionally, the 95% limits of agreement range from -27.48 to 26.66 dB HL at 0.5 kHz, from -18.19 to 17.87 dB HL at 1 kHz, from -12.01 to 22.55 dB HL at 2 kHz, and from -21.29 to 19.17 dB HL at 4 kHz, which are large enough to affect clinical decision-making.
In this study, we have confirmed good to excellent correlation between chirp-ASSR and PTA in threshold estimation for adults with and without hearing loss. The degree of correlations is higher for participants with hearing loss and for measurements at high frequencies. However, significant systematic difference and large limits of agreement between the 2 methods have been found. These findings show that chirp-ASSR can be treated as a supplementary method to PTA when evaluating the hearing level, but the 2 methods are not interchangeable due to their systematic difference and large limits of agreement.
啁啾听觉稳态响应（ASSR）可用于评估频率特异性听阈。然而，其可靠性尚未得到证实。本研究旨在通过分析啁啾-ASSR 和纯音测听（PTA）测量的阈值之间的一致性，来探讨啁啾-ASSR 在听阈评估中的价值。
分别对正常听力（年龄：18-66 岁，108 耳）和感音神经性听力损失患者（年龄：22-82 岁，75 耳）进行 PTA 和啁啾-ASSR 测试，测试频率分别为 0.5、1、2 和 4 kHz。采用组内相关系数（ICC）和 Bland-Altman 图分析两种方法的一致性。
108 名参与者同时接受了啁啾-ASSR 和 PTA 测试以估计其阈值。两种方法在 0.5、1、2 和 4 kHz 载波频率下的 ICC 值分别为 0.757、0.893、0.883 和 0.921（p<0.001）。然而，在 2 kHz 时两种方法之间存在显著差异：ASSR 阈值的平均值比 PTA 阈值高 5.27 dB HL。此外，0.5 kHz 时的 95%一致性界限范围为-27.48 至 26.66 dB HL，1 kHz 时为-18.19 至 17.87 dB HL，2 kHz 时为-12.01 至 22.55 dB HL，4 kHz 时为-21.29 至 19.17 dB HL，这些范围足够大，可能会影响临床决策。
在这项研究中，我们已经证实了成人听力损失和非听力损失者在阈值估计中，啁啾-ASSR 与 PTA 之间具有良好到极好的相关性。对于听力损失者和高频测量，相关性的程度更高。然而，两种方法之间存在显著的系统差异和较大的一致性界限。这些发现表明，在评估听力水平时，啁啾-ASSR 可以作为 PTA 的补充方法，但由于存在系统差异和较大的一致性界限，两种方法不能互换。
