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The clinical usefulness of the multiple auditory steady-state response technique in adults

Wendy D'Haenens UGent (2009)
abstract
The auditory steady-state response (ASSR) is an auditory evoked potential technique which can be used in difficult-to-test populations (infants, individuals with multiple handicaps, subjects who simulate hearing loss) to objectively estimate behavioural thresholds. The ASSR technique is gradually emerging in clinical settings because of some definite advantages over the commonly used click-evoked auditory brainstem response such as frequency-specific assessment of the auditory sensitivity, objective detection algorithms, higher stimulation levels, and multiple frequency stimulation. The main aim of this doctoral thesis is to assess the clinical usefulness of the auditory steady-state technique for an adult population using a commercially available multiple auditory steady-state response or the so-called clinical MASTER system. In particular, this research project focuses on two aspects consisting of optimization of the test efficiency and investigation of the clinical behaviour of the ASSR. The results demonstrate that the multiple ASSR technique accurately estimates pure-tone thresholds in adults with normal hearing and hearing loss using the AM²/FM stimulus. Investigation of the test-retest reliability demonstrates that in normal hearing adults a threshold difference of at least 20 dB is required to be 95% confident that the change in ASSR thresholds represents a true threshold shift instead of measurement error typical to the ASSR technique. Additionally, the impact of degree, type and configurations of hearing loss on ASSR threshold accuracy was assessed. The effect of degree shows that moderate sensorineural hearing loss (SNHL) has lower difference thresholds than normal hearing and that it is very difficult to categorize ASSR thresholds as normal or mild SNHL for 500 Hz and as mild or moderate SNHL for 2000 Hz. The impact of type of hearing loss reveals that air-conduction ASSR thresholds accurately predict the degree of conductive hearing loss, except for 2000 Hz. Furthermore, flat configurations of sensorineural hearing loss results in lower difference thresholds than the sloping SNHL, especially for the lower frequencies. Evaluation of the sensitivity, specificity, positive and negative predictive value reveals that the most appropriate cutoff point to differentiate normal hearing from hearing loss in adults is a 30 dB or lower criterion. The last study attempts to optimize the test efficiency of the ASSR technique by determining stopping criteria that can be used in a clinical setting and efforts are made to provide a framework by which a clinical audiologist can collect significant and non-significant response amplitude data to determine noise stop criteria for specific populations (infants and adults with varying degrees, types and configurations of hearing loss). In conclusion, the present thesis demonstrates that the multiple-ASSR technique accurately determines pure-tone thresholds using the novel proposed AM²/FM stimulus with a clinically acceptable test-retest reliability for normal hearing adults. Furthermore, distinguishing subjects with a mild degree of SNHL from normal hearing will be very difficult and air-conduction ASSR thresholds can be determined quite accurately in conductive hearing impaired patients. Finally, procedures to establish clinically efficient stopping criteria were proposed with a special focus on the framework to construct setting-specific noise-stop criteria. The next step will be investigating infants with varying degrees, types and configurations of hearing loss to establish the clinical usefulness for the ultimate target group of the ASSR technique.
Please use this url to cite or link to this publication:
author
promoter
UGent and UGent
organization
year
type
dissertation (monograph)
subject
keyword
Hearing impairment, Stopping criteria, Multiple Auditory Steady-state Response, Test-retest reliability
pages
189 pages
publisher
Ghent University. Faculty of Medicine and Health Sciences
place of publication
Ghent, Belgium
defense location
Gent : Het Pand (zaal rector Vermeylen)
defense date
2009-10-19 18:00
language
English
UGent publication?
yes
classification
D1
additional info
dissertation consists of copyrighted materials
copyright statement
I have transferred the copyright for this publication to the publisher
id
1055666
handle
http://hdl.handle.net/1854/LU-1055666
date created
2010-10-08 09:56:30
date last changed
2010-10-11 15:24:29
@phdthesis{1055666,
  abstract     = {The auditory steady-state response (ASSR) is an auditory evoked potential technique which can be used in difficult-to-test populations (infants, individuals with multiple handicaps, subjects who simulate hearing loss) to objectively estimate behavioural thresholds. The ASSR technique is gradually emerging in clinical settings because of some definite advantages over the commonly used click-evoked auditory brainstem response such as frequency-specific assessment of the auditory sensitivity, objective detection algorithms, higher stimulation levels, and multiple frequency stimulation. 
The main aim of this doctoral thesis is to assess the clinical usefulness of the auditory steady-state technique for an adult population using a commercially available multiple auditory steady-state response or the so-called clinical MASTER system. In particular, this research project focuses on two aspects consisting of optimization of the test efficiency and investigation of the clinical behaviour of the ASSR. 
The results demonstrate that the multiple ASSR technique accurately estimates pure-tone thresholds in adults with normal hearing and hearing loss using the AM{\texttwosuperior}/FM stimulus. Investigation of the test-retest reliability demonstrates that in normal hearing adults a threshold difference of at least 20 dB is required to be 95\% confident that the change in ASSR thresholds represents a true threshold shift instead of measurement error typical to the ASSR technique. Additionally, the impact of degree, type and configurations of hearing loss on ASSR threshold accuracy was assessed. The effect of degree shows that moderate sensorineural hearing loss (SNHL) has lower difference thresholds than normal hearing and that it is very difficult to categorize ASSR thresholds as normal or mild SNHL for 500 Hz and as mild or moderate SNHL for 2000 Hz. The impact of type of hearing loss reveals that air-conduction ASSR thresholds accurately predict the degree of conductive hearing loss, except for 2000 Hz. Furthermore, flat configurations of sensorineural hearing loss results in lower difference thresholds than the sloping SNHL, especially for the lower frequencies. Evaluation of the sensitivity, specificity, positive and negative predictive value reveals that the most appropriate cutoff point to differentiate normal hearing from hearing loss in adults is a 30 dB or lower criterion. The last study attempts to optimize the test efficiency of the ASSR technique by determining stopping criteria that can be used in a clinical setting and efforts are made to provide a framework by which a clinical audiologist can collect significant and non-significant response amplitude data to determine noise stop criteria for specific populations (infants and adults with varying degrees, types and configurations of hearing loss). 
In conclusion, the present thesis demonstrates that the multiple-ASSR technique accurately determines pure-tone thresholds using the novel proposed AM{\texttwosuperior}/FM stimulus with a clinically acceptable test-retest reliability for normal hearing adults. Furthermore, distinguishing subjects with a mild degree of SNHL from normal hearing will be very difficult and air-conduction ASSR thresholds can be determined quite accurately in conductive hearing impaired patients. Finally, procedures to establish clinically efficient stopping criteria were proposed with a special focus on the framework to construct setting-specific noise-stop criteria. The next step will be investigating infants with varying degrees, types and configurations of hearing loss to establish the clinical usefulness for the ultimate target group of the ASSR technique.},
  author       = {D'Haenens, Wendy},
  keyword      = {Hearing impairment,Stopping criteria,Multiple Auditory Steady-state Response,Test-retest reliability},
  language     = {eng},
  pages        = {189},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {The clinical usefulness of the multiple auditory steady-state response technique in adults},
  year         = {2009},
}

Chicago
D’Haenens, Wendy. 2009. “The Clinical Usefulness of the Multiple Auditory Steady-state Response Technique in Adults”. Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
APA
D’Haenens, W. (2009). The clinical usefulness of the multiple auditory steady-state response technique in adults. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Vancouver
1.
D’Haenens W. The clinical usefulness of the multiple auditory steady-state response technique in adults. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2009.
MLA
D’Haenens, Wendy. “The Clinical Usefulness of the Multiple Auditory Steady-state Response Technique in Adults.” 2009 : n. pag. Print.