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Test-retest reliability of speech-evoked auditory brainstem response in healthy children at a low sensation level

Zakaria MN, Jalaei B

Int J Pediatr Otorhinolaryngol, 2017 Nov;102:28-31.
PMID: 29106871 DOI: 10.1016/j.ijporl.2017.08.033

OBJECTIVE: Auditory brainstem responses evoked by complex stimuli such as speech syllables have been studied in normal subjects and subjects with compromised auditory functions. The stability of speech-evoked auditory brainstem response (speech-ABR) when tested over time has been reported but the literature is limited. The present study was carried out to determine the test-retest reliability of speech-ABR in healthy children at a low sensation level.
METHODS: Seventeen healthy children (6 boys, 11 girls) aged from 5 to 9 years (mean = 6.8 ± 3.3 years) were tested in two sessions separated by a 3-month period. The stimulus used was a 40-ms syllable /da/ presented at 30 dB sensation level.
RESULTS: As revealed by pair t-test and intra-class correlation (ICC) analyses, peak latencies, peak amplitudes and composite onset measures of speech-ABR were found to be highly replicable. Compared to other parameters, higher ICC values were noted for peak latencies of speech-ABR.
CONCLUSION: The present study was the first to report the test-retest reliability of speech-ABR recorded at low stimulation levels in healthy children. Due to its good stability, it can be used as an objective indicator for assessing the effectiveness of auditory rehabilitation in hearing-impaired children in future studies.
Gender and modulation frequency effects on auditory steady state response (ASSR) thresholds

Zakaria MN, Jalaei B, Wahab NA

Eur Arch Otorhinolaryngol, 2016 Feb;273(2):349-54.
PMID: 25682179 DOI: 10.1007/s00405-015-3555-3

For estimating behavioral hearing thresholds, auditory steady state response (ASSR) can be reliably evoked by stimuli at low and high modulation frequencies (MFs). In this regard, little is known regarding ASSR thresholds evoked by stimuli at different MFs in female and male participants. In fact, recent data suggest that 40-Hz ASSR is influenced by estrogen level in females. Hence, the aim of the present study was to determine the effect of gender and MF on ASSR thresholds in young adults. Twenty-eight normally hearing participants (14 males and 14 females) were enrolled in this study. For each subject, ASSR thresholds were recorded with narrow-band chirps at 500, 1,000, 2,000, and 4,000 Hz carrier frequencies (CFs) and at 40 and 90 Hz MFs. Two-way mixed ANOVA (with gender and MF as the factors) revealed no significant interaction effect between factors at all CFs (p > 0.05). The gender effect was only significant at 500 Hz CF (p < 0.05). At 500 and 1,000 Hz CFs, mean ASSR thresholds were significantly lower at 40 Hz MF than at 90 Hz MF (p < 0.05). Interestingly, at 2,000 and 4,000 Hz CFs, mean ASSR thresholds were significantly lower at 90 Hz MF than at 40 Hz MF (p < 0.05). The lower ASSR thresholds in females might be due to hormonal influence. When recording ASSR thresholds at low MF, we suggest the use of gender-specific normative data so that more valid comparisons can be made, particularly at 500 Hz CF.
Fulltext Mode of recording and modulation frequency effects of auditory steady state response thresholds

Jalaei B, Shaabani M, Zakaria MN

Braz J Otorhinolaryngol, 2017 Jan-Feb;83(1):10-15.
PMID: 27102175 DOI: 10.1016/j.bjorl.2015.12.005

INTRODUCTION: The performance of auditory steady state response (ASSR) in threshold testing when recorded ipsilaterally and contralaterally, as well as at low and high modulation frequencies (MFs), has not been systematically studied.

OBJECTIVE: To verify the influences of mode of recording (ipsilateral vs. contralateral) and modulation frequency (40Hz vs. 90Hz) on ASSR thresholds.

METHODS: Fifteen female and 14 male subjects (aged 18-30 years) with normal hearing bilaterally were studied. Narrow-band CE-chirp(®) stimuli (centerd at 500, 1000, 2000, and 4000Hz) modulated at 40 and 90Hz MFs were presented to the participants' right ear. The ASSR thresholds were then recorded at each test frequency in both ipsilateral and contralateral channels.

RESULTS: Due to pronounced interaction effects between mode of recording and MF (p<0.05 by two-way repeated measures ANOVA), mean ASSR thresholds were then compared among four conditions (ipsi-40Hz, ipsi-90Hz, contra-40Hz, and contra-90Hz) using one-way repeated measures ANOVA. At the 500 and 1000Hz test frequencies, contra-40Hz condition produced the lowest mean ASSR thresholds. In contrast, at high frequencies (2000 and 4000Hz), ipsi-90Hz condition revealed the lowest mean ASSR thresholds. At most test frequencies, contra-90Hz produced the highest mean ASSR thresholds.

CONCLUSIONS: Based on the findings, the present study recommends two different protocols for an optimum threshold testing with ASSR, at least when testing young adults. This includes the use of contra-40Hz recording mode due to its promising performance in hearing threshold estimation.
Abnormal Auditory Brainstem Response (ABR) Findings in a Near-Normal Hearing Child with Noonan Syndrome

Jalaei B, Zakaria MN, Sidek D

Iran J Otorhinolaryngol, 2017 Jan;29(90):53-57.
PMID: 28229064

INTRODUCTION: Noonan syndrome (NS) is a heterogeneous genetic disease that affects many parts of the body. It was named after Dr. Jacqueline Anne Noonan, a paediatric cardiologist.
CASE REPORT: We report audiological tests and auditory brainstem response (ABR) findings in a 5-year old Malay boy with NS. Despite showing the marked signs of NS, the child could only produce a few meaningful words. Audiological tests found him to have bilateral mild conductive hearing loss at low frequencies. In ABR testing, despite having good waveform morphology, the results were atypical. Absolute latency of wave V was normal but interpeak latencies of wave's I-V, I-II, II-III were prolonged. Interestingly, interpeak latency of waves III-V was abnormally shorter.
CONCLUSION: Abnormal ABR results are possibly due to abnormal anatomical condition of brainstem and might contribute to speech delay.
Are speech-evoked auditory brainstem response (speech-ABR) outcomes influenced by ethnicity?

Zakaria MN, Jalaei B, Aw CL, Sidek D

Neurol Sci, 2016 Jun;37(6):943-8.
PMID: 26921173 DOI: 10.1007/s10072-016-2522-0

Due to its objective nature, auditory brainstem response (ABR) evoked by complex stimuli has been gaining attention lately. The present study aimed to compare the speech-evoked auditory brainstem response (speech-ABR) results between two ethnic groups: Malay and Chinese. In addition, it was also of interest to compare the speech-ABR outcomes obtained from the present study with the published Caucasian data. Thirty healthy male adults (15 Malay and 15 Chinese) were enrolled in this comparative study. Speech syllable/da/presented at 80 dBnHL was used to record speech-ABR waveforms from the right ear of each subject. Amplitudes and latencies of speech-ABR peaks (V, A, C, D, E, F and O), as well as composite onset measures (V/A duration, V/A amplitude and V/A slope) were computed and analyzed. When the two ethnic groups were compared, all speech-ABR results were not statistically different from each other (p > 0.05). When the data from the present study were compared with the published Caucasian data, most of the statistical analyses were significant (p
Fulltext Gender differences in binaural speech-evoked auditory brainstem response: are they clinically significant?

Jalaei B, Azmi MHAM, Zakaria MN

Braz J Otorhinolaryngol, 2018 05 17;85(4):486-493.
PMID: 29858160 DOI: 10.1016/j.bjorl.2018.04.005

INTRODUCTION: Binaurally evoked auditory evoked potentials have good diagnostic values when testing subjects with central auditory deficits. The literature on speech-evoked auditory brainstem response evoked by binaural stimulation is in fact limited. Gender disparities in speech-evoked auditory brainstem response results have been consistently noted but the magnitude of gender difference has not been reported.
OBJECTIVE: The present study aimed to compare the magnitude of gender difference in speech-evoked auditory brainstem response results between monaural and binaural stimulations.
METHODS: A total of 34 healthy Asian adults aged 19-30 years participated in this comparative study. Eighteen of them were females (mean age=23.6±2.3 years) and the remaining sixteen were males (mean age=22.0±2.3 years). For each subject, speech-evoked auditory brainstem response was recorded with the synthesized syllable /da/ presented monaurally and binaurally.
RESULTS: While latencies were not affected (p>0.05), the binaural stimulation produced statistically higher speech-evoked auditory brainstem response amplitudes than the monaural stimulation (p<0.05). As revealed by large effect sizes (d>0.80), substantive gender differences were noted in most of speech-evoked auditory brainstem response peaks for both stimulation modes.
CONCLUSION: The magnitude of gender difference between the two stimulation modes revealed some distinct patterns. Based on these clinically significant results, gender-specific normative data are highly recommended when using speech-evoked auditory brainstem response for clinical and future applications. The preliminary normative data provided in the present study can serve as the reference for future studies on this test among Asian adults.
Gender Disparities in Speech-evoked Auditory Brainstem Response in Healthy Adults

Jalaei B, Zakaria MN, Mohd Azmi MH, Nik Othman NA, Sidek D

Ann Otol Rhinol Laryngol, 2017 Apr;126(4):290-295.
PMID: 28177264 DOI: 10.1177/0003489417690169

OBJECTIVES: Gender disparities in speech-evoked auditory brainstem response (speech-ABR) outcomes have been reported, but the literature is limited. The present study was performed to further verify this issue and determine the influence of head size on speech-ABR results between genders.
METHODS: Twenty-nine healthy Malaysian subjects (14 males and 15 females) aged 19 to 30 years participated in this study. After measuring the head circumference, speech-ABR was recorded by using synthesized syllable /da/ from the right ear of each participant. Speech-ABR peaks amplitudes, peaks latencies, and composite onset measures were computed and analyzed.
RESULTS: Significant gender disparities were noted in the transient component but not in the sustained component of speech-ABR. Statistically higher V/A amplitudes and less steeper V/A slopes were found in females. These gender differences were partially affected after controlling for the head size.
CONCLUSIONS: Head size is not the main contributing factor for gender disparities in speech-ABR outcomes. Gender-specific normative data can be useful when recording speech-ABR for clinical purposes.