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Electrophysiology > ABR - Thresholds > Flashcards

ABR - Thresholds Flashcards

1
Q

What are 5 reasons to have an early screening program (for any disorder)?

A
  1. importance of the disorder’s prevalence
  2. diagnosis of condition
  3. treatment resources for condition
  4. responsiveness to treatment
  5. advantages of early intervention
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2
Q

What deficits are hearing impaired infants at risk for?

A
  • speech/language problems
  • academic issues
  • social and emotional development problems
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3
Q

How long has the ABR been a part of NBHS procedures?

A

since 1980

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4
Q

What health bodies came together to develop a mandatory, universal NBHS program?

A

NIH, American Academy of Pediatrics, and JCIH

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5
Q

What is the purpose of the Early Hearing Detection and Intervention (EHDI) program statewide?

A
  • to ID every child born with a permanent HL
  • before 3 months old
  • provide appropriate intervention services before 6 months old
  • family support/medical home
  • hearing screening tracking
  • data management systems for public health info
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6
Q

What factors are used in every single NBHS?

A
  • sensitivity (low false negatives)
  • specificity (low false positives)
  • cost
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7
Q

What consists of the JCIH 2019 guidelines for NBHS?

A
  • use either automated OAEs or automated ABR
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8
Q

What OAE protocols are used for NBHS?

A
  • transient OAEs
  • distortion product OAEs (influenced by outer and middle ear problems)
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9
Q

When should we not use OAEs as a screening measure for newborns?

A

when they’re in the NICU (because they can be at higher risk for ANSD, and OAEs don’t catch this)

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10
Q

What is tested with the ABR during NBHS?

A

peripheral auditory nervous system and the brainstem

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11
Q

When should ABR screening be recommended for newborns?

A

when they’ve spent at least 5 days in the NICU

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12
Q

Babies in the NICU are more at risk for what conditions?

A
  • ANSD
  • late-onset progressive HL
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13
Q

Babies/infants with neuropathy will…

A

pass their OAE screen, but fail their ABR

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14
Q

What is the JCIH’s guideline for rescreening?

A

a single repeat screen should be conducted if the infant doesn’t pass their initial screening before they’re discharged (preferably several hours after the first)

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15
Q

When should NBHS be performed?

A

6 hours after birth, but better to do closer to discharge time (this reduces referrals)

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16
Q

How many NBHS can be performed before discharge of the baby?

A
  • 2 high quality (asleep or resting quietly) before discharge
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17
Q

How many NBHS can be performed post discharge of the baby?

A

one, before referral to a pediatrician

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18
Q

When should NBHS be done for babies born in a birthing center?

A

in the first 2 weeks of life

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19
Q

If a baby is born with congenital atresia, what should be done?

A

refer for complete audio logic eval rather than doing screening

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20
Q

What is the NBHS protocol when using OAEs?

A
  • TOAEs: broadband responses from clicks
  • DPOAEs: fx-specific response from a nonlinear tone pair
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21
Q

What are some disadvantages of using OAEs for NBHS?

A
  • the state of the outer/middle ear can influence results
  • info on IHCs or auditory nerves not obtained
  • can cause high referral rates and high quantity of false-positives
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22
Q

The use of ABR for NBHS exhibits a…

A

lower susceptibility to ME pathology, and a higher ability to detect retro-cochlear impairments

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23
Q

What is the clinical sensitivity and specificity for ABR?

A

100% sensitivity
97-100% for specificity

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24
Q

What consists of the pass/fail criteria for hearing screenings with ABR?

A
  • pass = presence of wave V
  • fail = absence of wave V
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25
Q

What is the protocol for hearing screenings with ABR?

A
  • click stimulus
  • presentation level of 35 dB nHL (for confirming normal hearing or mild HL)
  • presentation level of 70 dB nHL (for determining greater HL) if failed at 35 dB
  • repetition rate of about 23-37 clicks
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26
Q

What is the JCIH recommended protocol for hearing screenings (2019)?

A
  • 2-stage screening and rescreening with either OAE or A-ABR before hospital discharge
27
Q

What does the JCIH suggest to do if the baby doesn’t pass the initial A-ABR?

A

re-screening should be done using A-ABR again because persistent transient ME problems may decrease the sensitivity of OAE

28
Q

The 2019 JCIH guidelines recommend A-ABR for which situations?

A

screening and re-screening of NICU infants (due to their higher risk for ANSD)

29
Q

The 2019 JCIH guidelines recommend what for babies who don’t pass their A-ABR?

A

be referred to an AuD for re-screening, and complete a full ABR is needed

30
Q

The 2019 JCIH guideline recommends what for when a child fails their discharge screening?

A
  • post discharge screenings should 1, performed asap or within a month
  • failure on this re-screening in one or both ears = a complete diagnostic ABR eval
31
Q

What are some perinatal risk factors for hearing loss (JCIH, 2019)?

A
  • early, progressive, late-onset permanent childhood HL in family history
  • more than 5 days in the NICU
  • hyperbilirubinemia w/ exchange transfusion (regardless of length of stay)
  • more than 5 days of amino glycoside administration
  • asphyxia or hypoxic ischemic encephalopathy
  • extracorporeal membrane oxygenation
  • in utero infection (herpes, rubella, syphilis, toxoplasmosis, or cytomegalovirus
  • mother + for Zika, while infant exhibits no symptoms/clinical findings
  • mother + for Zika, with infant exhibiting symptoms/clinical findings
  • mother + for Zika, with infant exhibiting no symptoms, but displays clinical findings
  • birth conditions (microtia, atresia, ear dysplasia, oral/facial cleating, white forelock, microphthalmia, microcephaly, congenital/acquired hydrocephalus, temporal bone abnormalities
  • presence of one of over 400 syndromes characterized by atypical hearing thresholds
32
Q

What are some perinatal and postnatal risk factors (JCIH, 2019)?

A
  • positive cultures for infections linked to SNHL (confirmed bacterial and viral meningitis or encephalitis)
  • events that result in HL (significant head trauma or chemotherapy)
  • concerns by caregivers in terms of hearing, speech, language, developmental delay, and/or developmental regression
33
Q

When does the JCIH recommend a diagnostic eval to confirm the presence/degree of HL for babies?

A

when they don’t pass the 2 stages of screening

34
Q

What can be used for fx-specific threshold estimation before the baby is 2-3 months old?

A
  • ABR or ASSR to determine type, degree, and configuration of the HL
  • use tone bursts or chirps as stimuli
  • intervention should between 3-6 months
35
Q

Fx-specific stimuli for ABRS are ideal for what?

A

to ensure that ABR thresholds reflect the pure tone audiogram (represents the primary activity in the cochlea restricted to a specific place corresponding to the fx, rather than a broad area like with chirps and clicks)

36
Q

What type of stimuli does the JCIH (2019) recommend for estimating AC thresholds through ABR and ASSR?

A

fx-specific (tone bursts/chirps)

37
Q

ABR thresholds can overestimate or underestimate what when measuring?

A
  • can overestimate behavioral thresholds with normal hearing
  • can underestimate behavioral thresholds with HL
38
Q

What causes the discrepancy between ABR thresholds and estimation?

A
  • the differential effects of stimulus duration due to reduced temporal integration of behavioral and ABR thresholds
39
Q

Estimating BC thresholds with fx-specific tone bursts/chirps can be used to what?

A
  • accurately quantify the magnitude of the conductive components and to differentiate normal vs impaired cochlear sensitivity in infants with conductive, mixed, or SNHL
40
Q

What indicates a conductive HL when using ABR to estimate thresholds?

A

if the AC-ABR is elevated in the presence of normal BC-ABR thresholds

41
Q

What indicates SNHL when using ABR to estimate thresholds?

A

if both the AC and BC-ABR thresholds are elevated

42
Q

Estimating BC thresholds with fx-specific tone bursts/chirps can be used to what?

A

to accurately quantify the magnitude of the conductive component and to differentiate normal vs impaired cochlear sensitivity in infants with conductive, mixed, or SNHL

43
Q

Obtaining BC thresholds are essential for?

A

estimating additional HA gain and output in the presence of conductive HL

44
Q

Fx-specific chirp stimuli elicit…

A

larger wave V amplitudes compared to traditional click and fx specific tone burst stimuli

45
Q

Fxs and intensities of stimuli used for estimating BC-ABR thresholds are…

A
  • fxs: most studies limited to 500-2000 Hz
  • intensities: most clinicians use 30 and 20 dB nHL as normal levels for 500 and 2,000
46
Q

First step for estimating AC and BC thresholds with ABR

A
  • start with AC
  • start with 2k Hz (important for speech and psychoacoustics) tone burst and replicate using a starting level equal to the minimal level of 30 dB nHL
47
Q

ABR-AC and BC threshold estimation procedure:

A
  • if response isn’t clear at minimum level and is inconclusive, obtain 2 responses at 10 dB above the minimum level
  • if response is present: the 10 dB level is the upper bracket for the threshold, and threshold would be between 30-40 dB nHL
48
Q

Once you obtain a 2k Hz threshold for one ear, what does the protocol say to do?

A

switch to opposite ear and repeat procedure

49
Q

After switching to opposite ear and repeating procedure at 2k Hz, what is next?

A
  • obtain bilateral responses for 4k Hz (this fx is quicker because responses are more robust and clearer)
  • then obtain bilateral responses for 500 Hz
50
Q

What is done if no AC-ABR response is obtained at the minimum level (30 dB)?

A
  • obtain a response at 60 dB and continue to 80 dB
  • now beginning to suspect HL (need to determine type)
51
Q

Do you need to remove inserts to obtain BC thresholds in infants?

A

no - the occlusion effect doesn’t occur in infants

52
Q

What do you do if both AC and BC-ABR thresholds are elevated?

A

switch to BC-ABR threshold search and bracketing at 500 Hz (minimum level 25 dB) before shifting to 4k Hz
- if a conductive component is found at 2k Hz, it might not be necessary to obtain accurate estimate of BC-ABR threshold at 500 Hz (you can expect the presence of a conductive component at 500 Hz)
- BUT, the presence of a conductive component at 500 Hz can’t rule out a possible SNHL component at 2k Hz

53
Q

If the AC-ABR at 4k Hz is the only fx showing an elevated threshold, then what else has to be obtained?

A

BC-ABR threshold estimates for that fx

54
Q

When are AC-ABR threshold estimates at 1k Hz required?

A

ONLY if the difference between AC-ABR thresholds in dB nHL is 25 dB

55
Q

A 5 dB final bracketing step is recommended for when?

A

when the ABR threshold estimates are greater than 70 dB estimated hearing level

56
Q

Response detection criteria legend

A
  • TH: threshold
  • RP: response positive
  • NR: no response
  • INC: inconclusive response
57
Q

When is the RP considered a TH?

A

when the RP and NR are separated by 10 dB

58
Q

What is needed for there to be “no response”?

A

requires an RP at a 10 dB higher level as a reference, and essentially flat replicated tracings of at least 1k sweeps at a level 10 dB below

59
Q

How do we derive the estimated hearing level (dB eHL)?

A

by applying correction factors determined from a normative statistical relationship between ABD and behavioral thresholds

60
Q

What does the Eclipse software correction factors include?

A
  • 20 dB at 500 Hz
  • 15 dB at 1k Hz
  • 10 dB at 2k Hz
  • 5 dB at 4k Hz
61
Q

What is the typical masking stimulus used for ABR?

A

white noise since clicks are a broadband stimulus

62
Q

How much masking noise is needed for ABR?

A

it has to be enough to elevate the hearing threshold in the non-test ear in order to prevent cross-over of sound

63
Q

AC-ABR masking criteria:

A
  • no masking needed if absolute latencies of waves I, and V are normal
  • if these latencies are abnormal, masking is needed
64
Q

BC-ABR masking criteria:

A
  • not required if wave I is present at normal latencies
  • required if wave I is delayed or absent

Electrophysiology (5 decks)

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