Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers: tutorial
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J Am Acad Audiology 1–15 (2019)Abstract: 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, 2018) 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 steadystate
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 FMP, 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, 2018).
Details and rationales for changing test strategies and protocols are given and case examples are used to
illustrate.
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, 2018) 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 steadystate
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 FMP, 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, 2018).
Details and rationales for changing test strategies and protocols are given and case examples are used to
illustrate.