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Wendy D’haenens, MSc; Ingeborg Dhooge, MD, PhD; Leen Maes, MSc; Annelies Bockstael, MSc; Hannah Keppler, MSc; Birgit Philips, MSc; Freya Swinnen, MSc; Bart M. Vinck, MSc, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(5):496-506.

Objectives  To determine the ability of the air-conduction multiple-frequency auditory steady-state response (ASSR) technique to diagnose normal hearing (NH) and mild and moderate degrees of sensorineural hearing loss (SNHL), to assess patients with conductive hearing loss (CHL), to evaluate flat and sloping configurations of hearing impairment, and to provide sensitivity and specificity values for various ASSR cutoff criteria.

Design  A comparative study between ASSR and criterion-standard behavioral thresholds.

Setting  Ear, nose, and throat department at a university hospital.

Patients  The study population comprised 40 adults with NH, 17 with SNHL, and 7 with CHL.

Main Outcome Measures  The measure of interest was the difference between ASSR and behavioral thresholds at 0.5, 1.0, 2.0, and 4.0 kHz. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were calculated for several ASSR cutoff criteria.

Results  The ASSR technique clearly distinguished moderate SNHL from NH, but the "mild SNHL and NH" and "mild SNHL and moderate SNHL" differentiation was particularly difficult at 0.5 and 2.0 kHz, respectively. Air-conduction ASSR thresholds accurately predicted behavioral thresholds in CHL. The ASSR system precisely reflected the flat and sloping configurations. Finally, the most appropriate ASSR cutoff point for normality seems to be the 30-dB-or-lower criterion.

Conclusions  In adults, the multiple-frequency 80-Hz ASSR technique can be used to determine the degree and configuration of hearing loss. Although air-conduction ASSR thresholds accurately predicted behavioral thresholds in CHL, future research with bone-conduction ASSRs is necessary to establish the type of hearing loss. Furthermore, the applicability of these findings still needs to be confirmed for infants.

Author Affiliations: Ear, Nose, and Throat Department, Faculty of Medicine, Ghent University, Ghent, Belgium.

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