Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers

2019 ◽  
Author(s):  
Yvonne S. Sininger ◽  
Lisa L. Hunter ◽  
Patricia A. Roush ◽  
Sue Windmill ◽  
Deborah Hayes ◽  
...  
Keyword(s):  
Otoacoustic Emissions ◽  
New Technologies ◽  
Broad Band ◽  
Auditory Brainstem ◽  
Automated Detection ◽  
Infants And Toddlers ◽  
Test Protocol ◽  
Case Examples ◽  
Artifact Rejection ◽  
Brainstem Response

Background: Audiologists often lack confidence in results produced by current protocols for diagnosticelectrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols whichextend the time needed to complete the testing and consequently delay fitting of amplification. A recentpublication (Sininger et al, 2018) has shown how new technologies can be applied to electrophysiologictesting systems to improve confidence in results and allow faster test protocols. Average test times forcomplete audiogram predictions when using new technologies and protocols were found to be just over32 minutes using auditory brainstem response (ABR) and just under 20 minutes using auditory steadystateresponse (ASSR) technology.<br />Purpose: The purpose of this manuscript is to provide details of expedited test protocols for infant andtoddler diagnostic electrophysiologic testing.<br />Summary: Several new technologies and their role in test speed and confidence are described includingCE-Chirp stimuli, automated detection of ABRs using a technique called FMP, Bayesian weighting which isan alternative to standard artifact rejection and Next-Generation ASSR with improved response detectionand chirp stimuli. The test protocol has the following features: (1) preliminary testing includes impedancemeasures and otoacoustic emissions, (2) starting test levels are based on Broad-Band CE-Chirp thresholdsin each ear, (3) ABRs or ASSRs are considered present based on automated detection rather thanon replication of responses, (4) number of test levels is minimized, (5) ASSR generally evaluates fourfrequencies in each ear simultaneously with flexibility to change all test levels independently.<br />Conclusions: Combining new technologies with common-sense strategies has been shown to substantiallyreduce test times for predicting audiometric thresholds in infants and toddlers (Sininger et al, 2018).Details and rationales for changing test strategies and protocols are given and case examples are used toillustrate.

scholarly journals Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers

2020 ◽  
Vol 31 (06) ◽  
pp. 455-468
Author(s):  
Yvonne S. Sininger ◽  
Lisa L. Hunter ◽  
Patricia A. Roush ◽  
Sue Windmill ◽  
Deborah Hayes ◽  
...  
Keyword(s):  
Otoacoustic Emissions ◽  
New Technologies ◽  
Broad Band ◽  
Auditory Brainstem ◽  
Automated Detection ◽  
Infants And Toddlers ◽  
Test Protocol ◽  
Electrophysiologic Testing ◽  
Case Examples ◽  
Brainstem Response

Abstract Background Audiologists often lack confidence in results produced by current protocols for diagnostic electrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols which extend the time needed to complete the testing and consequently delay fitting of amplification. A recent publication (Sininger et al50) has shown how new technologies can be applied to electrophysiologic testing systems to improve confidence in results and allow faster test protocols. Average test times for complete audiogram predictions when using new technologies and protocols were found to be just over 32 minutes using auditory brainstem response (ABR) and just under 20 minutes using auditory steady-state response (ASSR) technology. Purpose The purpose of this manuscript is to provide details of expedited test protocols for infant and toddler diagnostic electrophysiologic testing. Summary Several new technologies and their role in test speed and confidence are described including CE-Chirp stimuli, automated detection of ABRs using a technique called F MP, Bayesian weighting which is an alternative to standard artifact rejection and Next-Generation ASSR with improved response detection and chirp stimuli. The test protocol has the following features: (1) preliminary testing includes impedance measures and otoacoustic emissions, (2) starting test levels are based on Broad-Band CE-Chirp thresholds in each ear, (3) ABRs or ASSRs are considered present based on automated detection rather than on replication of responses, (4) number of test levels is minimized, (5) ASSR generally evaluates four frequencies in each ear simultaneously with flexibility to change all test levels independently. Conclusions Combining new technologies with common-sense strategies has been shown to substantially reduce test times for predicting audiometric thresholds in infants and toddlers (Sininger et al50). Details and rationales for changing test strategies and protocols are given and case examples are used to illustrate.

Testing Babies: You Can Do It! Behavioral Observation Audiometry (BOA)

2011 ◽  
Vol 21 (2) ◽  
pp. 59-65
Author(s):  
Jane R. Madell
Keyword(s):  
Otoacoustic Emissions ◽  
Behavioral Observation ◽  
Auditory Brainstem ◽  
List Type ◽  
Direct Measure ◽  
Behavioral Testing ◽  
Test Protocol ◽  
The Status ◽  
Brainstem Response ◽  
And Performance

Behavioral observation audiometry (BOA) is the only test protocol that provides a direct measure of hearing. This valuable technique can be used to monitor hearing and hearing aid benefit in infants who are not yet able to participate in visual reinforcement audiometry (VRA). In this article, I present a carefully developed protocol that uses changes in sucking, resulting in a reliable threshold measures. Key points include Auditory brainstem response (ABR) testing, auditory steady state response (ASSR) testing, and otoacoustic emissions (OAEs) testing provide critical information about the status of the auditory pathways but are not direct measures of hearing. Only behavioral testing provides a direct measure of hearing. Behavioral testing can be used to monitor hearing and performance with hearing technology. When carefully performed, using appropriate criteria including using changes in sucking as an indication of a response, behavioral observation audiometry can be used by clinicians to accurately measure thresholds in infants cognitively less than 6 months of age.

The Effect of Kalman-Weighted Averaging and Artifact Rejection on Residual Noise During Auditory Brainstem Response Testing

2019 ◽  
Vol 28 (1) ◽  
pp. 114-124
Author(s):  
Linda W. Norrix ◽  
Julie Thein ◽  
David Velenovsky
Keyword(s):  
Repeated Measures ◽  
Auditory Brainstem ◽  
Weighted Averaging ◽  
Auditory Brainstem Responses ◽  
Residual Noise ◽  
Electrophysiological Recordings ◽  
Artifact Rejection ◽  
Brainstem Response ◽  
Active Motor ◽  
Averaging Time

Purpose Low residual noise (RN) levels are critically important when obtaining electrophysiological recordings of threshold auditory brainstem responses. In this study, we examine the effectiveness and efficiency of Kalman-weighted averaging (KWA) implemented on the Vivosonic Integrity System and artifact rejection (AR) implemented on the Intelligent Hearing Systems SmartEP system for obtaining low RN levels. Method Sixteen adults participated. Electrophysiological measures were obtained using simultaneous recordings by the Vivosonic and Intelligent Hearing Systems for subjects in 2 relaxed conditions and 4 active motor conditions. Three averaging times were used for the relaxed states (1, 1.5, and 3 min) and for the active states (1.5, 3, and 6 min). Repeated-measures analyses of variance were used to examine RN levels as a function of noise reduction strategy (i.e., KWA, AR) and averaging time. Results Lower RN levels were obtained using KWA than AR in both the relaxed and active motor states. Thus, KWA was more effective than was AR under the conditions examined in this study. Using KWA, approximately 3 min of averaging was needed in the relaxed condition to obtain an average RN level of 0.025 μV. In contrast, in the active motor conditions, approximately 6 min of averaging was required using KWA. Mean RN levels of 0.025 μV were not attained using AR. Conclusions When patients are not physiologically quiet, low RN levels are more likely to be obtained and more efficiently obtained using KWA than AR. However, even when using KWA, in active motor states, 6 min of averaging or more may be required to obtain threshold responses. Averaging time needed and whether a low RN level can be attained will depend on the level of motor activity exhibited by the patient.

Objective Assessment of Hearing in Children: Update on Procedures and Protocols

2011 ◽  
Vol 21 (2) ◽  
pp. 50-58
Author(s):  
James W. Hall ◽  
Anuradha R. Bantwal
Keyword(s):  
Psychosocial Development ◽  
Otoacoustic Emissions ◽  
Objective Assessment ◽  
Behavioral Assessment ◽  
Auditory Brainstem ◽  
Test Battery ◽  
Auditory Evoked Responses ◽  
Brainstem Response ◽  
Assessment Techniques ◽  
Pediatric Populations

Early identification and diagnosis of hearing loss in infants and young children is the first step toward appropriate and effective intervention and is critical for optimal communicative and psychosocial development. Limitations of behavioral assessment techniques in pediatric populations necessitate the use of an objective test battery to enable complete and accurate assessment of auditory function. Since the introduction of the cross-check principle 35 years ago, the pediatric diagnostic test battery has expanded to include, in addition to behavioral audiometry, acoustic immittance measures, otoacoustic emissions, and multiple auditory evoked responses (auditory brainstem response, auditory steady state response, and electrocochleography). We offer a concise description of a modern evidence-based audiological test battery that permits early and accurate diagnosis of auditory dysfunction.

Clinical Application of Otoacoustic Emissions: What do we Know about Factors Influencing Measurement and Analysis?

1994 ◽  
Vol 110 (1) ◽  
pp. 22-38 ◽  
Author(s):  
James W. Hall ◽  
Jane E. Baer ◽  
Patricia A. Chase ◽  
Mitchell K. Schwaber
Keyword(s):  
Otoacoustic Emissions ◽  
Large Scale ◽  
Auditory Brainstem ◽  
Distortion Product ◽  
Clinical Investigations ◽  
Gender And Age ◽  
Measurement And Analysis ◽  
The Everyday ◽  
Brainstem Response ◽  
Clinical Environments

Three electrophysiologic audiologic procedures-aural immittance measurement, auditory brainstem response (ABR), and otoacoustic emissions (OAE) — were first described in the 1970's. Immittance measurement and ABR have contributed importantly for years to the assessment of auditory function in children and adults, whereas OAEs have not yet been incorporated into the everyday audiology test battery. In this article, we argue that the transition from OAE measurement by hearing scientists in laboratory settings to routine application by audiologists in the clinic will be greatly facilitated by (1) comprehensive, large-scale studies of the effects of subject characteristics, such as gender and age (from infancy to advancing adulthood), on both transient evoked (TEOAE) and distortion product (DPOAE) otoacoustic emissions; (2) clinical investigations of TEOAE and DPOAE in sizeable patient populations with specific neurotologic diagnoses; (3) guidelines for OAE test protocols in clinical environments; and (4) clear criteria for OAE analysis in clinical populations.

scholarly journals Auditory pathway maturational study in small for gestational age preterm infants

CoDAS ◽  
2014 ◽  
Vol 26 (4) ◽  
pp. 286-293 ◽  
Author(s):  
Rosanna Giaffredo Angrisani ◽  
Edna Maria Albuquerque Diniz ◽  
Ruth Guinsburg ◽  
Alexandre Archanjo Ferraro ◽  
Marisa Frasson de Azevedo ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Otoacoustic Emissions ◽  
Newborn Infants ◽  
Tone Burst ◽  
Auditory Pathway ◽  
Auditory Brainstem ◽  
Cross Sectional ◽  
Brainstem Response

PURPOSE: To follow up the maturation of the auditory pathway in preterm infants small for gestational age (SGA), through the study of absolute and interpeak latencies of auditory brainstem response (ABR) in the first six months of age.METHODS: This multicentric prospective cross-sectional and longitudinal study assessed 76 newborn infants, 35 SGA and 41 appropriate for gestational age (AGA), born between 33 and 36 weeks in the first evaluation. The ABR was carried out in three moments (neonatal period, three months and six months). Twenty-nine SGA and 33 AGA (62 infants), between 51 and 54 weeks (corrected age), returned for the second evaluation. In the third evaluation, 49 infants (23 SGA and 26 AGA), with age range from 63 to 65 weeks (corrected age), were assessed. The bilateral presence of Transient Evoked Otoacoustic Emissions and normal tympanogram were inclusion criteria.RESULTS: It was found interaural symmetry in both groups. The comparison between the two groups throughout the three periods studied showed no significant differences in the ABR parameters, except for the latencies of wave III in the period between three and six months. As for the maturation with tone burst 0.5 and 1 kHz, it was found that the groups did not differ.CONCLUSION: The findings suggest that, in the premature infants, the maturational process of the auditory pathway occurs in a similar rate for SGA and AGA. These results also suggest that prematurity is a more relevant factor for the maturation of the auditory pathway than birth weight.

Normative Sweep Frequency Impedance Measures in Healthy Neonates

2014 ◽  
Vol 25 (04) ◽  
pp. 343-354 ◽  
Author(s):  
Venkatesh Aithal ◽  
Joseph Kei ◽  
Carlie Driscoll ◽  
Andrew Swanston ◽  
Katrina Roberts ◽  
...  
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Static Pressure ◽  
Auditory Brainstem ◽  
Ear Canal ◽  
Sweep Frequency ◽  
Tone Frequency ◽  
Automated Auditory Brainstem Response ◽  
Brainstem Response ◽  
Stapedial Reflex

Background: Diagnosing middle ear disorders in neonates is a challenging task for both audiologists and otolaryngologists. Although high-frequency (1000 Hz) tympanometry and acoustic stapedial reflex tests are useful in diagnosing middle ear problems in this age group, they do not provide information about the dynamics of the middle ear in terms of its resonance frequency (RF) and mobility. The sweep frequency impedance (SFI) test can provide this information, which may assist in the diagnosis of middle ear dysfunction in neonates. Purpose: This study aimed to investigate the feasibility of testing neonates using the SFI technique, establish normative SFI data for RF and mobility of the middle ear in terms of changes in sound pressure level (ΔSPL in dB), and describe the dynamics of the middle ear in healthy Australian neonates. Study Sample: A prospective sample of 100 neonates (58 males, 42 females) with a mean gestational age of 39.3 wk (SD = 1.3 wk; range = 38–42 wk), who passed all three tests, namely, automated auditory brainstem response, transient evoked otoacoustic emissions, and 1000 Hz tympanometry, were included in this study. Data Collection and Analysis: A SFI research prototype was used to collect the data. First, the SPL in the ear canal was measured as a probe-tone frequency was swept from 100–2000 Hz with the ear canal static pressure held constant at 200 daPa. Then, this measurement was repeated with the static pressure reduced in 50 daPa steps to –200 daPa. Additional measurement was also performed at the static pressure, where the peak of the 1000 Hz tympanogram occurred. A graph showing the variation of SPL against frequency at all static pressures was plotted. From this graph, the RF and ΔSPL at tympanometric peak pressure (TPP) were determined. Descriptive statistics and an analysis of variance (ANOVA) were applied to the RF and ΔSPL data with gender and ear as independent variables. Results: The results showed two resonance regions of the outer/middle ear with the high RF (mean = 1236 Hz; 90% range: 830–1518 Hz) being approximately equal to four times that of the low RF (mean = 287 Hz; 90% range = 209–420 Hz). The low RF was more easily identifiable than the high RF. The ΔSPL at the low RF (mean = 8.2 dB; 90% range = 3.4–13 dB) was greater than that at the high RF (mean = 5.0 dB; 90% range = 1.5–8.1 dB). There were no significant differences or interactions between genders and ears. Conclusion: The study showed that the SFI is a feasible test of middle ear function in neonates. The SFI results revealed two regions of resonance with the lower resonance (287 Hz) possibly related to the movements of the outer ear canal wall and higher resonance (1236 Hz) related to the resonance of the middle ear. The normative data developed in this study will be useful in evaluating outer and middle ear function in neonates.

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