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Pressurized Wideband Acoustic Stapedial Reflex Thresholds: Normal Development and Relationships to Auditory Function in Infants

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Abstract

This study analyzed effects of pressurization on wideband acoustic stapedial-muscle reflex (ASR) tests in infants cared for in normal newborn (NN) and neonatal intensive care units (NICU). Effects of hearing-screening outcomes on ASR threshold measurements were also evaluated, and a subsequent longitudinal study established normative threshold ranges over the first year after birth. An initial experiment compared thresholds in newborns measured at ambient pressure in the ear canal and at the tympanometric peak pressure. ASR thresholds for broadband noise were higher for ears that did not pass newborn hearing screening and ASR threshold was 14 dB higher for real-ear compared to coupler conditions. Effects of pressurization were significant for ears that passed screening; thus, ASR testing in infants should be conducted at tympanometric peak pressure. ASR threshold was significantly higher for ears that referred on transient evoked otoacoustic emissions and Auditory Brainstem Response (ABR) screening tests and also for ears with conductive and sensorineural hearing loss diagnosed by ABR. Developmental ASR changes were significant over the first year for both normal and NICU infants. Wideband pressurized ASR thresholds are a clinically relevant measure of newborn hearing screening and diagnostic outcomes.

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Abbreviations

ABR:

Auditory brainstem response

ANOVA:

Analysis of variance

ASR:

Acoustic stapedial reflex

ASRT:

ASR threshold

BBN:

Broad band noise

CCHMC:

Cincinnati Children’s Hospital Medical Center

CHL:

Conductive hearing loss

DPOAE:

Distortion Product Otoacoustic Emission

GSH:

Good Samaritan Hospital

LS:

Least Square

nHL:

Hearing Level referenced to normal hearing

NHS:

Newborn Hearing Screening

NN:

normal newborn

NICU:

Neonatal Intensive Care Unit

TEOAE:

Transient Evoked Otoacoustic Emission

peSPL:

Peak-to-peak equivalent sound pressure level

SNHL:

Sensorineural Hearing Loss

SPL:

Sound Pressure Level

TPP:

Tympanometric Peak Pressure

VRA:

Visual Reinforcement Audiometry

WB-ASRT:

Wideband ASRT

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Acknowledgments

The authors were assisted by John C. Ellison in preliminary analyses of these reflex data. Portions of these results were presented at the Association for Research in Otolaryngology in 2011 and the American Auditory Society in 2014. Research reported in this publication was supported by the National Institute of Deafness and other Communication Disorders of the National Institutes of Health under Award Number R01 DC010202 and an ARRA supplement (DC010202-01S1). Co-author Keefe is involved in commercializing devices to assess middle-ear function in infants. Lisa Hunter has received honoraria from Interacoustics, Inc. and Vivosonic, Inc. for educational lectures. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The content of this article does not represent the views of the Department of Veterans Affairs or of the US Government.

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Authors and Affiliations

  1. Division of Audiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45213, USA

    Lisa L. Hunter

  2. Boys Town National Research Hospital, 555 N. 30th St., Omaha, NE, 68131, USA

    Douglas H. Keefe & Denis F. Fitzpatrick

  3. National Center for Rehabilitative Auditory Research, Portland VA Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA

    M. Patrick Feeney

  4. Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    M. Patrick Feeney

Authors
  1. Lisa L. Hunter
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  2. Douglas H. Keefe
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  3. M. Patrick Feeney
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  4. Denis F. Fitzpatrick
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Correspondence to Lisa L. Hunter.

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Funding Source

Research reported in this publication was supported by the National Institute of Deafness and other Communication Disorders of the National Institutes of Health under Award Number R01 DC010202 and an ARRA supplement (DC010202-01S1). Co-author Keefe is involved in commercializing devices to assess middle-ear function in infants. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The content of this article does not represent the views of the Department of Veterans Affairs or of the United States Government.

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Hunter, L.L., Keefe, D.H., Feeney, M.P. et al. Pressurized Wideband Acoustic Stapedial Reflex Thresholds: Normal Development and Relationships to Auditory Function in Infants. JARO 18, 49–63 (2017). https://doi.org/10.1007/s10162-016-0595-3

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  • DOI: https://doi.org/10.1007/s10162-016-0595-3

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