AUDIOLOGIC DIAGNOSIS OF INFANTS

ABSTRACT

Audiologic diagnosis for infants requires an extensive test battery in order to provide all the information needed and wanted. Behavioral test methods continue to be an important tool, in particular visual reinforcement audiometry (VRA), with the limitation that children younger than 5 to 6 months of age cannot be expected to respond in a reliable way. Impedance audiometry provides an important means of assessing middle ear status, and the middle ear reflex also adds information about inner ear and cochlear nerve function. However, a higher probe tone frequency than the ordinary 226 Hz seems to provide more reliable test results in small children. Otoacoustic emissions are basic as a screening tool but in most cases provide little additional information on children with significant hearing loss, although there certainly are exceptions. The electrophysiologic methods form a very important part of the test battery. The recording of ABR is an obvious test when a hearing impairment is suspected. Electrocochleography provides more frequency-specific data and has the power of sometimes providing responses where no ABR can be recorded, especially when the transtympanic needle electrode is used. Steady-state evoked potentials (SSEP) constitute a relatively new test method with which rather few clinics so far have practical experience, but it certainly holds promise as an addition to the test battery allowing good frequency specificity and efficiency.

KEYWORD

Behavioral audiometry - impedance audiometry - auditory evoked potentials.

REFERENCES

• 1 Lidén G, Kankkunen A. Visual reinforcement audiometry.  Acta Otolaryngol (Stockh) . 1969;  67 281-292
• 2 Schneider B A, Trehub S E, Morrongiello B A, Thorpe L A. Auditory sensitivity in preschool children.  J Acoust Soc Am . 1986;  79 447-452
• 3 Trehub S E, Schneider B A, Endman M. Developmental changes in infants' sensitivity to octave band noises.  J Exp Child Psychol . 1980;  29 282-293
• 4 Werner L A, Marean G C. Methods for estimating infant thresholds.  J Acoust Soc Am . 1991;  90 1867-1875
• 5 Olsho L W, Koch E G, Carter E A. Pure-tone sensitivity of human infants.  J Acoust Soc Am . 1988;  84 1316-1324
• 6 Schneider B A, Trehub S E, Morrongiello B A, Thorpe L A. Developmental changes in masked thresholds.  J Acoust Soc Am . 1989;  86 1733-1742
• 7 Polich J M, Starr A. Middle-, late-, and long-latency auditory evoked potentials. In: Moore EJ, ed. Bases of Auditory Brain-Stem Evoked Responses New York: Grune & Stratton 1983: 345-361
• 8 Stockard J E, Stockard J J. Recording and analyzing. In: Moore EJ, ed. Bases of Auditory Brain-Stem Evoked Responses New York: Grune & Stratton 1983: 255-286
• 9 Mendel M I. Evoked cochlear potentials. In: Gerber SE, ed. Audiometry in Infancy New York: Grune & Stratton 1977: 183-203
• 10 Gerber S E. Auditory development. In: Gerber SE, ed. Audiometry in Infancy New York: Grune & Stratton 1977: 71-81
• 11 Schneider B A, Trehub S E. Developmental change in auditory sensitivity. In: Werner LA, Rubel EW, eds. Developmental Psychoacoustics Washington, DC: American Psychological Association 1992: 3-46
• 12 Kankkunen A. Pre-school children with impaired hearing in Göteborg 1964-1980.  Acta Otolaryngol (Stockh) . 1982;  1-124 (1-124)
• 13 Moore J M, Wilson W R. Visual reinforcement audiometry (VRA) with infants. In: Gerber SE, Mencher GT, eds. Early Diagnosis of Hearing Loss New York: Grune & Stratton 1978: 177-213
• 14 Widen J E. Behavioral screening of high-risk infants using visual reinforcement audiometry.  Semin Hear . 1990;  11 342-355
• 15 Werner L A, Gillenwater J M. Pure-tone sensitivity of 2- to 5-week-old infants.  Infant Behav Dev . 1990;  13 355-375
• 16 Kankkunen A, Lidén G. Respiration audiometry.  Scand Audiol . 1977;  6 81-86
• 17 Wedenberg E. The awakening test. The auro-palpebral reflex.  Acta Otolaryngol (Stockh) . 1965;  94 (94)
• 18 Weatherby L A, Bennett M J. The neonatal acoustic reflex.  Scand Audiol . 1980;  9 103-110
• 19 Poulsen G, Tos M. Screening tympanometry in newborn infants and during the first six months of life.  Scand Audiol . 1978;  7 159-166
• 20 Sutton G J, Gleadle P, Rowe S J. Tympanometry and otoacoustic emissions in a cohort of special care neonates.  Br J Audiol . 1996;  30 9-17
• 21 Niemeyer W, Sesterhenn G. Calculating the hearing threshold from the stapedius reflex threshold for different sound stimuli.  Audiology . 1974;  13 421-427
• 22 Jerger J, Hayes D, Anthony L. Effect of age on prediction of sensorineural hearing level from the acoustic reflex.  Arch Otolaryngol . 1978;  104 393-394
• 23 Hyde M L, Alberti P W, Morgan P P, Symons F, Cummings F. Pure tone threshold estimation from acoustic reflex thresholds-a myth?.  Acta Otolaryngol (Stockh) . 1980;  89 345-357
• 24 Aran J M. The electrocochleogram: recent results in children and in some pathological cases.  Arch Klin Exp Ohr Nas Kehlkopf Heilk . 1971;  198 128-141
• 25 Bergholtz L M, Arlinger S D, Kylén P, Jerlvall L B. Electrocochleography used as a clinical hearing test in difficult-to-test children.  Acta Otolaryngol (Stockh) . 1977;  84 385-392
• 26 Schoonhoven R, Lamoré P JJ, de Laat J P M A, Grote J J. The prognostic value of electrocochleography in severely hearing-impaired infants.  Audiology . 1999;  38 141-154
• 27 Schoonhoven R, Fabius M AW, Grote J J. Input/output curves to tone bursts and clicks in extratympanic and transtympanic electrocochleography.  Ear Hear . 1995;  16 619-630
• 28 Ruth R A, Horner J S, McCoy G S, Chandler C R. Comparison of auditory brainstem response and behavioral audiometry in infants.  Scand Audiol . 1983;  94-98 (94-98)
• 29 Hyde M L, Riko K, Malizia K. Audiometric accuracy of the click ABR in infants at risk for hearing loss.  J Am Acad Audiol . 1990;  1 59-66
• 30 Brookhouser P E, Gorga M P, Kelly W J. Auditory brainstem response results as predictors of behavioral auditory thresholds in severe and profound hearing impairment.  Laryngoscope . 1990;  100 803-810
• 31 Durieux-Smith A, Picton T W, Bernard P. Prognostic validity of brainstem electric response audiometry in infants of a neonatal intensive care unit.  Audiology . 1991;  30 249-265
• 32 Stapells D R, Gravel J S, Martin B A. Thresholds for auditory brain stem responses to tones in notched noise from infants and young children with normal hearing or sensorineural hearing loss.  Ear Hear . 1995;  16 361-371
• 33 Rickards F W, Tan L E, Cohen L T. Auditory steady-state evoked potentials in newborns.  Br J Audiol . 1994;  28 327-337
• 34 Rance G, Rickards F W, Cohen L T. The automated prediction of hearing thresholds in sleeping subjects using auditory steady-state evoked potentials.  Ear Hear . 1995;  16 499-507
• 35 Lins O G, Picton T W, Boucher B L. Frequency specific audiometry using steady-state responses.  Ear Hear . 1996;  17 81-96
• 36 Mauer G, Doering W H. Appropriate modulation frequencies for recording of amplitude modulation following response (AMFR) in young cochlear implant candidates. In: Proceedings of the Fifth European Symposium on Paediatric Cochlear Implantation, Antwerp, June 4-7, 2000: 71