title: Are auditory steady-state responses a good tool prior to pediatric cochlear implantation?
abstract: BACKGROUND
  ASSR allow frequency-specific evaluation in intensities up to 120dB HL and detection of residual hearing in patients with severe-to-profound hearing loss.
  
  
  OBJECTIVE
  to compare ASSR thresholds and behavioral test results in children with suspected severe-to-profound hearing loss.
  
  
  METHODS
  Cross sectional study to compare ASSR and behavioral responses (VRA or audiometry) in 63 pediatric cochlear implant candidates (126 ears) aged between 6 and 72 months. We included children with normal otomicroscopy, absent responses to click-ABR and otoaccoustic emissions. We excluded children with inner ear malformations, auditory neuropathy spectrum disorder or who did not complete VRA or achieve EEG noise<30nV during the ASSR test. Air-conduction ASSR stimuli were continuous sinusoidal tones presented at 0.5, 1, 2 and 4kHz starting at 110dB HL. Behavioral thresholds were acquired with warble tones presented at 0.5, 1, 2 and 4kHz in each ear through insert or head phones at maximum presentation level of 120dB HL.
  
  
  RESULTS
  Behavioral thresholds were obtained in 36.7% (185/504) of all frequencies in all subjects, 9% in intensities >110dB HL. Among 504 ASSR measurements, 53 thresholds were obtained (10.5%). Overall 89.5% of the tested frequencies did not show any response at 110dB HL. Most responses were at 500Hz. Mean differences between behavioral and ASSR thresholds varied from 0.09 to 8.94dB. Twenty-seven comparisons of behavioral and ASSR thresholds were obtained: 12 at 0.5kHz, 9 at 1kHz, 5 at 2kHz and 1 at 4kHz. Absent responses were observed in both tests in 38.1% at 0.5kHz, 52.4% at 1kHz, 74.6% at 2kHz and 81.0% at 4kHz. Specificity was>90% at 1, 2 and 4kHz. In ears with no behavioral response at 120dB HL all ASSR thresholds were in the profound hearing loss range, 90% of them were ≥110dB HL.
  
  
  CONCLUSIONS
  Among 63 pediatric CI candidates, absent responses to high-intensity ASSR was the major finding (specificity>90%) predicting behavioral thresholds in the profound hearing loss range. These findings can be helpful to confirm the decision for cochlear implantation.
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil. Electronic address: robertomobeck@gmail.com.
authors.forename: Roberto Miquelino de Oliveira
authors.initials: RM
authors.lastname: Beck
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil.
authors.forename: Signe Schuster
authors.initials: SS
authors.lastname: Grasel
authors.affiliation: University of Espirito Santo (UFES), 514, Fernando Ferrari Avenue-Goiabeiras, Vitória, ES, 29075-910, Brazil.
authors.forename: Henrique Faria
authors.initials: HF
authors.lastname: Ramos
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil.
authors.forename: Edigar Rezende de
authors.initials: ER
authors.lastname: Almeida
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil.
authors.forename: Robinson Koji
authors.initials: RK
authors.lastname: Tsuji
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil.
authors.forename: Ricardo Ferreira
authors.initials: RF
authors.lastname: Bento
authors.affiliation: University of Sao Paulo School of Medicine, 255, Dr. Enéas de Carvalho Aguiar Street, Sao Paulo, SP, 05403-000, Brazil.
authors.forename: Rubens de
authors.initials: Rd
authors.lastname: Brito
mesh_terms: D001299:Audiometry / Q000379:methods*; D001309:Auditory Threshold / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003430:Cross-Sectional Studies; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Auditory evoked potentials; Auditory thresholds; Cochlear implantation; Hearing loss; Residual hearing