J Am Acad Audiol 2020; 31(06): 455-468
DOI: 10.3766/jaaa.19046
American Academy of Audiology. All rights reserved. (2020) American Academy of Audiology

Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers

Yvonne S. Sininger
1   C & Y Consultants, Santa Fe, NM
Lisa L. Hunter
2   Department of Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
3   Department of Communication Disorders, University of Cincinnati, Cincinnati, OH
Patricia A. Roush
4   Department of Otolaryngology, Head and Neck Surgery, University of North Carolina Medical Center, Chapel Hill, NC
Sue Windmill
2   Department of Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Deborah Hayes
5   Department of Pediatrics, Colorado School of Medicine, Denver, CO
6   Department of Physical Medicine and Rehabilitation, Colorado School of Medicine, Denver, CO
Kristin M. Uhler
5   Department of Pediatrics, Colorado School of Medicine, Denver, CO
6   Department of Physical Medicine and Rehabilitation, Colorado School of Medicine, Denver, CO
› Author Affiliations
Funding This study was supported by a grant from the Oticon Foundation.
Further Information

Publication History

Publication Date:
03 August 2020 (online)


Background Audiologists often lack confidence in results produced by current protocols for diagnostic electrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols which extend the time needed to complete the testing and consequently delay fitting of amplification. A recent publication (Sininger et al[50]) has shown how new technologies can be applied to electrophysiologic testing systems to improve confidence in results and allow faster test protocols. Average test times for complete audiogram predictions when using new technologies and protocols were found to be just over 32 minutes using auditory brainstem response (ABR) and just under 20 minutes using auditory steady-state response (ASSR) technology.

Purpose The purpose of this manuscript is to provide details of expedited test protocols for infant and toddler diagnostic electrophysiologic testing.

Summary Several new technologies and their role in test speed and confidence are described including CE-Chirp stimuli, automated detection of ABRs using a technique called F MP, Bayesian weighting which is an alternative to standard artifact rejection and Next-Generation ASSR with improved response detection and chirp stimuli. The test protocol has the following features: (1) preliminary testing includes impedance measures and otoacoustic emissions, (2) starting test levels are based on Broad-Band CE-Chirp thresholds in each ear, (3) ABRs or ASSRs are considered present based on automated detection rather than on replication of responses, (4) number of test levels is minimized, (5) ASSR generally evaluates four frequencies in each ear simultaneously with flexibility to change all test levels independently.

Conclusions Combining new technologies with common-sense strategies has been shown to substantially reduce test times for predicting audiometric thresholds in infants and toddlers (Sininger et al[50]). Details and rationales for changing test strategies and protocols are given and case examples are used to illustrate.

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