Comparison of hearing thresholds obtained from auditory brainstem response and auditory steady state response in infants and young children in Malta

Abstract

Hearing Loss (HL) is a common impairment found in neonates and has been receiving global attention. Screening and further diagnostics identifies new-borns at risk of developing HL which prevents social isolation, improves language development as well as promotes academic and social development later in life. The World Health Organisation (WHO) and other jurisdictions around the globe aim at achieving universal screening through the Universal New-born Hearing Screening (UNHS) programme. It is estimated that 34 million children have this disability. There are many screening and testing methods which are mostly electrophysiology or behavioural. Screening is normally done through Otoacoustic Emissions (OAEs) while actual diagnostics uses Auditory Brainstem Response (ABR) which is the gold standard with Auditory Steady-State Response (ASSR) as an alternative. Various other methods have also been proposed and tested. While ABR, ASSR and OAEs are widely used, clinical data show disparities in terms of accuracy, specificity, reliability and other problems. The hearing thresholds and other results from ABR and ASSR show significant deviations which calls for further investigation. The current study performed a comparative analysis between ABR and ASSR based on data collected from Malta healthcare facility between 2021 to 2022. The participant were children aged 3 - 96months. 109 cases were screened using OAE and further objective auditory testing done using ABR and ASSR at 2kHz and 4kHz. Prospective data was collected using a questionnaire. Data was then analysed using Statistical package for social sciences (SPSS). Descriptive statistics examined demographics and other sample characteristics. Inferential statistics evaluated correlations between ABR/ ASSR at 2kHz and 4kHz frequencies using Kappa agreement. Regression analysis evaluated whether independent factors age and OAE screening predicted or influenced the outcome of ABR and ASSR results. The results indicate medium level correlation between ABR and ASSR with Kappa value ranging between 0.546 – 0.600 at a statistical significance p < 0.001 at 95% CI. Thus, ABR and ASSR are correlated but one cannot substitute the other. Regression analysis indicates that OAE screening is a predictor variable for later testing using ABR and ASSR as all tests were statistically significant. The participants’ age did not affect ABR and ASSR results in most evaluations with the exception of Rt and Lt Average ABR and Rt ABR at 2kHz. The results are consistent with previous studies. The main limitation was that audio vestibular tests at 0.5k and 1k were not available. In culmination, OAE screening and further objective testing using ABR and ASSR is imperative.