Center for Hearing Research, Boys Town National Research Hospital, Omaha, NE.
Audiology Program, Phoenix Children's Hospital, AZ.
Am J Audiol. 2023 Jun;32(2):391-402. doi: 10.1044/2023_AJA-22-00180. Epub 2023 Apr 11.
Common clinical application of auditory brainstem response (ABR) testing is limited to 0.25-4 kHz. Prior research has demonstrated associations between ABR and behavioral thresholds for tone burst stimuli > 4 kHz in adults, but there are no comparable data for children. The ability to predict behavioral thresholds > 4 kHz clinically based on the ABR would provide valuable audiologic information for individuals who are unable to provide behavioral thresholds. This study included children with hearing loss and children with normal hearing to determine the association between ABR and behavioral thresholds at 6 and 8 kHz.
ABR and behavioral thresholds were obtained for children ages 4.7-16.7 years ( = 10.5, = 3.4) with sensorineural hearing loss ( = 24) or normal hearing sensitivity ( = 16) and for adults ages 18.4-54.4 years ( = 32.7, = 10.4) with sensorineural hearing loss ( = 13) or normal hearing sensitivity ( = 11). Thresholds obtained for 6 and 8 kHz using ABR and conventional audiometry were compared.
Differences between ABR and behavioral thresholds averaged 5-6 dB for both children and adults for both test frequencies, with differences of ≤ 20 dB in all instances. Linear mixed modeling for data from participants with hearing loss suggested that ABR threshold is a good predictor of behavioral threshold at 6 and 8 kHz for both children and adults. Test specificity was 100%; no participants with behavioral thresholds ≤ 20 dB HL had ABR thresholds > 25 dB nHL.
Initial evidence suggests that ABR testing at 6 and 8 kHz is reliable for estimating behavioral threshold in listeners with hearing loss and accurately identifies normal hearing sensitivity. The results of this study contribute to efforts to improve outcomes for vulnerable populations by reducing barriers to clinical implementation of ABR testing at > 4 kHz.
听觉脑干反应（ABR）测试的常见临床应用仅限于 0.25-4 kHz。先前的研究表明，在成人中，ABR 与>4 kHz 的啁啾刺激的行为阈值之间存在关联，但对于儿童则没有可比的数据。基于 ABR 预测>4 kHz 的行为阈值的能力将为无法提供行为阈值的个体提供有价值的听力信息。本研究包括听力损失儿童和听力正常儿童，以确定 ABR 与 6 和 8 kHz 的行为阈值之间的关系。
对 4.7-16.7 岁（n=10.5，SD=3.4）有感觉神经性听力损失（n=24）或正常听力敏感性（n=16）的儿童和 18.4-54.4 岁（n=32.7，SD=10.4）有感觉神经性听力损失（n=13）或正常听力敏感性（n=11）的成人进行 ABR 和行为阈值测试。比较使用 ABR 和常规听力测试在 6 和 8 kHz 获得的阈值。
对于两个测试频率，儿童和成人的 ABR 与行为阈值之间的差异平均为 5-6 dB，所有情况下的差异均≤20 dB。对于听力损失参与者的数据进行线性混合模型分析表明，ABR 阈值是儿童和成人 6 和 8 kHz 行为阈值的良好预测指标。测试特异性为 100%；没有行为阈值≤20 dB HL 的参与者的 ABR 阈值>25 dB nHL。
初步证据表明，6 和 8 kHz 的 ABR 测试可可靠地估计听力损失患者的行为阈值，并准确识别正常听力敏感性。本研究的结果有助于通过减少>4 kHz 时 ABR 测试的临床实施障碍来改善弱势群体的结果。
