Swanepoel (2011) reports that the unique stimuli (including chirps, clicks, and white noise) in tandem with the recording and analysis characteristics of modern auditory steady state response (ASSR) protocols allow applications previously not possible with regard to infants and children.
He reports that ASSR should be used in combination with frequency-specific ABR, not in place of frequency specific ABR at this time. Swanepoel notes that ASSR may be considered to demonstrate how well the brain “follows” periodic changes (modulation frequency) of the stimulus. He reports that the advantages of ASSR include the ability to present multiple stimuli (500, 1000, 2000, and 4000 Hz) simultaneously to both ears.
Of note, multiple frequency presentations are only recommended up to approximately 80 dB HL (to avoid “after-interactions”). ASSR can assess hearing levels greater than 100 dB HL, thus allowing the differentiation of severe and profound hearing loss, which cannot be typically differentiated via ABR and which may allow a more appropriate choice of intervention/therapy, such as hearing aids versus cochlear implants.
Swanepoel notes with regard to bone conduction testing via ASSR, that reliable thresholds can be determined in pre-term, term, and older infants with normal hearing. In cases of suspected hearing loss, procedural adaptations may allow more accurate bone conduction thresholds.
For More information, References, and Recommendations
Beck DL, Speidel DP, Petrak M.( 2008) Innovations In Technology; Auditory Steady-State Response: A Beginner's Guide, September, Hearing Products Report.
Beck DL, Speidel DP, Petrak M.( 2007) Auditory Steady-State Response: A Beginner's Guide, September, Hearing Review.
Beck DL, Speidel DP, Craig JG. (2009) Developments in Auditory Steady-State Responses (ASSR). Hearing Review, August, 2009.
D’haenens W, Vinck BM, DeVel E, Maes L, Bockstael A, Keppler H, Philips B, Swinnen F, Dhooge I. (2008) Auditory Steady-State Responses in Normal Hearing Adults: A Test Re-Test Reliability Study. International Journal of Audiology 47(8):489-498.
Jafari Z, Malayeri S, Ashayeri H, Farrahani MA. (2009) Adults with Auditory Neuropathy: Comparison of Auditory Steady State Response and Pure Tone Audiometry. Journal of the American Academy of Audiology 20(10):621-628.
Picton TW, van Room P, John MS. (2009) Multiple Auditory Steady State Responses (80 to 101 Hz): Effects of Ear, Gender, Handedness, Intensity and Modulation rate. Ear and Hearing 30(1):100-109.
Swanepoel DW. (2011) Clinical Status of the Auditory Steady-State Response In Infants. Seminars in Hearing 32(2):163-171.
Van Maamen AV, Stapells DR. (2010) Multiple-ASSR Thresholds in Infants and Young Children With Hearing Loss. Journal of the American Academy of Audiology 21(8):535-545.