Threshold changes of ABR results in toddlers and children.

INTRODUCTION: Auditory brainstem response (ABR) is a clinically established method to identify the hearing threshold in young children and is regularly performed after hearing screening has failed. Some studies have shown that, after the first diagnosis of hearing impairment in ABR, further development takes place in a spectrum between progression of hearing loss and, surprisingly, hearing improvement. OBJECTIVE: The aim of this study is to evaluate changes over time of auditory thresholds measured by ABR among young children. MATERIAL AND METHODS: For this retrospective study, 459 auditory brainstem measurements were performed and analyzed between 2010 and 2014. Hearing loss was detected and assessed according to national guidelines. 104 right ears and 101 left ears of 116 children aged between 0 and 3 years with multiple ABR measurements were included. The auditory threshold was identified using click and/or NB-chirp-stimuli in natural sleep or in general anesthesia. The frequency of differences of at least more than 10dB between the measurements was identified. RESULTS: In 37 (35%) measurements of right ears and 38 (38%) of left ears there was an improvement of the auditory threshold of more than 10dB; in 27 of those measurements more than 20dB improvement was found. Deterioration was seen in 12% of the right ears and 10% of the left ears. Only half of the children had stable hearing thresholds in repeated measurements. The time between the measurements was on average 5 months (0 to 31 months). CONCLUSION: Hearing threshold changes are often seen in repeated ABR measurements. Therefore multiple measurements are necessary when ABR yields abnormal. Hearing threshold changes should be taken into account for hearing aid provision.

Comparison between ABR with click and narrow band chirp stimuli in children.

OBJECTIVE: Click and chirp-evoked auditory brainstem responses (ABR) are applied for the estimation of hearing thresholds in children. The present study analyzes ABR thresholds across a large sample of children's ears obtained with both methods. The aim was to demonstrate the correlation between both methods using narrow band chirp and click stimuli. METHODS: Click and chirp evoked ABRs were measured in 253 children aged from 0 to 18 years to determine their individual auditory threshold. The delay-compensated stimuli were narrow band CE chirps with either 2000 Hz or 4000 Hz center frequencies. Measurements were performed consecutively during natural sleep, and under sedation or general anesthesia. Threshold estimation was performed for each measurement by two experienced audiologists. RESULTS: Pearson-correlation analysis revealed highly significant correlations (r=0.94) between click and chirp derived thresholds for both 2 kHz and 4 kHz chirps. No considerable differences were observed either between different age ranges or gender. Comparing the thresholds estimated using ABR with click stimuli and chirp stimuli, only 0.8-2% for the 2000 Hz NB-chirp and 0.4-1.2% of the 4000 Hz NB-chirp measurements differed more than 15 dB for different degrees of hearing loss or normal hearing. CONCLUSION: The results suggest that either NB-chirp or click ABR is sufficient for threshold estimation. This holds for the chirp frequencies of 2000 Hz and 4000 Hz. The use of either click- or chirp-evoked ABR allows a reduction of recording time in young infants. Nevertheless, to cross-check the results of one of the methods, we recommend measurements with the other method as well.