The Role of Auditory Steady State Response (ASSR) in Audiology Today James W. Hall III, Ph.D. Clinical Professor and Chair Department of Communicative Disorders College of Health Professions University of Florida Gainesville, FL 32610 [email protected]
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The Role of Auditory Steady State Response (ASSR)in Audiology Today
James W. Hall III, Ph.D.
Clinical Professor and ChairDepartment of Communicative Disorders
College of Health ProfessionsUniversity of Florida
Phase coherence valuesare statisticallydifference from noise
ASSR (Audera):No Response Condition
ASSR (Audera):Significant phase coherence
ASSR (Audera):Estimated Audiogram
Time Waveform Amplitude Spectrum%AM %FM
0 0
100 0
50 0
0 50
0 20
50 20
0 25 ms 0 2 kHz
+1.0
-1.0
1.0
0.0MM
500100020004000
EEG + ASSR
ASSR with MASTER:Detecting the signal using F test
•Takes into account the variance of the noise along with the variance of the response
• F-ratio of Significance must have a p<.05 or better
• Response color plot• Red = >.101• Yellow = .051 - .101• Green = <.050
Historical perspectiveGeneral principlesAnatomy and physiology InstrumentationStimulus and analysisLiterature reviewClinical features
advantages disadvantages
AUDITORY STEADY STATE RESPONSE (ASSR)ASSESSMENT IN INFANCY: Strengths and Weaknesses
Auditory Steady State Responses (ASSRs):Selected Literature from the Australian Group
Rickards & Clark. Steady-state evoked potentials to amplitude modulated tones.In Evoked Potentials II. Boston: Butterworth, 1984.
Rickards et al. Auditory steady-state evoked responses in newborns. BritishJournal of Audiology 28: 1994.
Rance, Rickards et al. The automated prediction of hearing thresholds insleeping subjects using steady state evoked potentials. Ear & Hearing 16: 1995.
Rance, Dowell, Rickards et al. Steady-state evoked potential and behavioralhearing thresholds in a group of children with absent click-evoked ABRs. Ear &Hearing 19: 1998.
Rance, Beer, Cone-Wesson et al. Clinical findings for a group of infants andyoung children with auditory neuropathy. Ear & Hearing 20: 1999.
Rance & Briggs. Assessment of hearing in infants with moderate to profoundimpairment: The Melbourne experience with auditory steady-state evokedpotential testing. Ann Otol Rhinol Laryngol 111: 2002
Auditory Steady State Responses (ASSRs):Selected Literature from the Canadian Group
Linden, Campbell, Hamel, Picton: Human auditory steady state evoked potentialsduring sleep. Ear & Hearing 6: 1985.
Valdes, Perez-Abalo et al. Comparison of statistical indicators for the automaticdetection of 80 Hz auditory steady state responses. Ear & Hearing 18: 1997.
Picton et al. Objective evaluation of aided thresholds using auditory steady-stateresponses. JAAA 9: 1998.
John & Picton. Human auditory steady-state responses to amplitude-modulatedtones: phase and latency measurements. Hearing Research 141: 2000.
John & Picton. MASTER: A Windows program for recording multiple auditorysteady-state reponses. Computer Methods and Programs in Biomedicine 61: 2000.
Dimitrijevic, John, van Roon, Picton. Human auditory steady-state responses totones independently modulated in both frequency and amplitude. Ear & Hearing22: 2001.
The Auditory Steady State Response: Part I.J Amer Acad Audiol 13 (4) special issue, April 2002.
Cone-Wesson B, Dowell RC, Tomlin D, Rance G, MingWJ. The auditory steady-state response: Comparisonswith the auditory brainstem response. [U. of Arizona andMelbourne, Australia]
Kuwada et al. Sources of scalp-recorded amplitude-modulated following response. [U. of Connecticut]
Dimitrijevic, Picton, et al. Estimating the audiogramusing multiple auditory steady-state responses.[Toronto]
The Auditory Steady State Response: Part I.J Amer Acad Audiol 13 (5) special issue, May 2002.
Cone-Wesson, Rickards, et al. The auditory steady-stateresponse: Clinical observations and applications in infants andchildren. [U. of Arizona and Melbourne, Australia]
Cone-Wesson, Parker, Swiderski, Rickards. The auditory steadystate evoked response: full-term and premature neonates [U. ofArizona]
Rance & Richards. Prediction of hearing thresholds in infantsusing auditory steady state evoked potentials [Melbourne]
Vander Werff, Brown, Gienapp, Schmidt. Comparison of auditorysteady state response and auditory brainstem responsethresholds in children. [U. of Iowa]
John, Purcell, Dimitrijevic, Picton. Advantages and caveats whenrecording steady state responses to multiple simultaneousstimuli [U. of Toronto]
Historical perspectiveGeneral principlesAnatomy and physiology InstrumentationStimulus and analysisLiterature reviewClinical features
advantages disadvantages
AUDITORY STEADY STATE RESPONSE (ASSR)ASSESSMENT IN INFANCY: Strengths and Weaknesses
ASSR, ABR, and Pure Tone Audiometry:Asking the clinically relevant question
Not:Which frequency-specific electrophysiologictechnique is best … tone burst ABR or ASSR?
But:How does the ASSR technique complementclick and tone burst ABR techniques in theinfant test battery?
Tone Burst ABR versus Auditory Steady StateResponse (ASSR): Advantages and Disadvantages
Auditory dysfunction ABR ASSR
Normal hearing accurate estimation may over-estimate thresholds if patient is not sedated
Conductive HL ear-specific findings bone conduction tone-burst bone conduction measures but masking required
without masking (wave I presence)
Sensory HL accurate only to accurate from moderate to moderate HL degree profound HL
Neural / Auditory identified with wave I cannot distinguish profoundNeuropathy or CM sensory versus neural HL
Normal hearing sensitivity 54% (40)
Hearing loss 46% (34)Conductive 26% (9)Sensory 44% (15)