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Reliability of auditory steady-state response to bone conduction stimuli in assessing hearing loss in children




This study was designed to investigate bone Conduction (BC)/auditory steady state response (ASSR) in children with normal hearing, together with various types of hearing loss, to find out an objective method to differentiate between different types of hearing loss.

Participants and methods

A total of 80 children (with ages ranging between 3 and 6 years) were subjected to history taking, otological examination, and basic audiological evaluation in the form of pure-tone audiometry (air Conduction (AC), BC). Single monotic ASSR (AC, BC) was tested at 0.5, 1, 2, and 4 kHz. They were classified on the basis of hearing status into three categories (20 children each): category I, normal hearing; category II, sensorineural hearing Loss (SNHL) (subdivided into two groups: group 1, mild-to-moderate SNHL; and group 2, severe-to-profound SNHL), and category III, conductive hearing loss.


BC thresholds were poorer for ASSR testing compared with thresholds obtained with behavioral testing in normal category using 9, 7.5, 5.5, and 10.5 dBHL at 0.5, 1, 2, and 4 kHz, respectively. In category II, in the mild-to-moderate SNHL group, it was poorer using 16.25, 5.75, 12.25, and 11.75 dBHL at the same measured frequencies. Minimum levels at which spurious BC/ASSR occurred were established in the group with severe-to-profound SNHL as 52, 66.5, 69, and 64 dBHL at 0.5, 1, 2, and 4 kHz, respectively (no BC/pure tone audiometry (PTA) could be measured). In conductive hearing loss (CHL) category, it was poorer using 12.5, 8.5, 9.5, and 9 dBHL at 0.5, 1, 2, and 4 kHz, respectively. Preliminary normal levels for BC/ASSR at 0.5, 1, 2, and 4 kHz were 23.5, 22.5, 20, and 25 dBHL, respectively. In children with conductive hearing loss, the average BC/ASSR thresholds corresponded closely to those in the normal-hearing group.


BC/ASSR thresholds could be recorded reliably in children with normal hearing and conductive hearing losses. Meanwhile, BC/ASSR may not provide a reliable measure in cases of SNHL, especially cases with moderate or greater loss due to the low levels at which spurious responses may occur.


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Correspondence to Hanaa Fadel MSC.

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There are no conflicts of interest.

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Ismaila, N., El-Saiid, E., El Sebaii, A. et al. Reliability of auditory steady-state response to bone conduction stimuli in assessing hearing loss in children. Egypt J Otolaryngol 32, 196–201 (2016).

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  • children
  • hearing loss
  • play audiometry