The Impact of Degree of Hearing Loss on Auditory Brainstem Response Predictions of Behavioral Thresholds
The Impact of Degree of Hearing Loss on Auditory Brainstem Response Predictions of Behavioral Thresholds
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DOI：
10.1097/aud.0000000000000213
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发表时间：
2015-05-01
期刊：
影响因子：
3.7
通讯作者：
Gorga, Michael P.
中科院分区：
文献类型：
--
作者：
McCreery, Ryan W.;Kaminski, Jan;Gorga, Michael P.
目的：婴幼儿听力损失的诊断和放大处方需要基于听觉脑干反应（ABR）测量准确估计耳朵和频率特异性行为阈值。虽然ABR和行为阈值之间的整体关系已被证明，协议是不完美的，和基于ABR的行为阈值的预测的准确性可能取决于听力损失的程度。行为阈值低于ABR阈值，至少部分是由于与时间整合效应相互作用的校准差异，时间整合效应在行为测量中而不是ABR测量中表现出来，并且取决于行为阈值。感觉性听力损失的听者表现出减少或缺乏时间整合，这可能会影响ABR和行为阈值之间的关系，随着听力损失程度的增加。本研究评估了婴儿和儿童在一系列听力阈值范围内ABR和行为阈值之间的关系，并测试了一种基于ABR测量估计的听力损失程度调整校正因子的方法。设计：对177名听力正常至极重度听力损失儿童的309耳临床记录进行了回顾性分析，ABR和行为阈值均可用。在两次评估中，要求儿童具有相同的中耳状态。分析ABR与行为阈值的关系。分析了可能影响ABR和行为阈值之间关系的因素，包括ABR上观察到的听力损失程度、行为测试方法（视觉强化、条件性游戏或常规测听）、ABR和行为评估之间的时间长度以及临床医生报告的行为评估可靠性。预测准确性的校正因子的基础上的ABR和行为阈值之间的差异作为ABR阈值的函数进行了比较，通过其他两个校正方法在目前的临床使用的预测准确性：正如预期的那样，ABR阈值是一个显着的预测行为阈值。ABR和行为阈值之间的协议作为听力损失程度的函数而变化。测试方法，评估之间的时间长度，和报告的可靠性的行为测试结果是不相关的ABR和行为阈值之间的差异。一个校正因子的基础上的差异ABR和行为阈值作为ABR阈值的函数之间的线性关系导致更准确地预测行为阈值比其他校正因子在临床use.Conclusions：ABR是一个有效的预测行为阈值在婴儿和儿童。一个校正因子，占听力损失的程度对ABR和行为阈值之间的差异的影响，导致更准确的预测行为阈值的方法，使用一个恒定的校正因子，无论听力损失的程度。这些结果是一致的预测的基础上，以前的研究与听力损失的听众的时间整合。
Objectives: Diagnosis of hearing loss and prescription of amplification for infants and young children require accurate estimates of ear- and frequency-specific behavioral thresholds based on auditory brainstem response (ABR) measurements. Although the overall relationship between ABR and behavioral thresholds has been demonstrated, the agreement is imperfect, and the accuracy of predictions of behavioral threshold based on ABR may depend on degree of hearing loss. Behavioral thresholds are lower than ABR thresholds, at least in part due to differences in calibration interacting with the effects of temporal integration, which are manifest in behavioral measurements but not ABR measurements and depend on behavioral threshold. Listeners with sensory hearing loss exhibit reduced or absent temporal integration, which could impact the relationship between ABR and behavioral thresholds as degree of hearing loss increases. The present study evaluated the relationship between ABR and behavioral thresholds in infants and children over a range of hearing thresholds, and tested an approach for adjusting the correction factor based on degree of hearing loss as estimated by ABR measurements.Design: A retrospective review of clinical records was completed for 309 ears of 177 children with hearing thresholds ranging from normal to profound hearing loss and for whom both ABR and behavioral thresholds were available. Children were required to have the same middle ear status at both evaluations. The relationship between ABR and behavioral thresholds was examined. Factors that potentially could affect the relationship between ABR and behavioral thresholds were analyzed, including degree of hearing loss observed on the ABR, behavioral test method (visual reinforcement, conditioned play, or conventional audiometry), the length of time between ABR and behavioral assessments, and clinician-reported reliability of the behavioral assessment. Predictive accuracy of a correction factor based on the difference between ABR and behavioral thresholds as a function of ABR threshold was compared to the predictive accuracy achieved by two other correction approaches in current clinical use.Results: As expected, ABR threshold was a significant predictor of behavioral threshold. The agreement between ABR and behavioral thresholds varied as a function of degree of hearing loss. The test method, length of time between assessments, and reported reliability of the behavioral test results were not related to the differences between ABR and behavioral thresholds. A correction factor based on the linear relationship between the differences in ABR and behavioral thresholds as a function of ABR threshold resulted in more accurately predicted behavioral thresholds than other correction factors in clinical use.Conclusions: ABR is a valid predictor of behavioral threshold in infants and children. A correction factor that accounts for the effect of degree of hearing loss on the differences between ABR and behavioral thresholds resulted in more accurate predictions of behavioral thresholds than methods that used a constant correction factor regardless of degree of hearing loss. These results are consistent with predictions based on previous research on temporal integration for listeners with hearing loss.