Acoustic reflex on newborns: the influence of the 226 and 1,000 Hz probes

Jacob-Corteletti, Lílian Cássia Bórnia; Duarte, Josilene Luciene; Zucki, Fernanda; Mariotto, Luciane Domingues Figueiredo; Lauris, José Roberto Pereira; Alvarenga, Kátia de Freitas

doi:10.1590/2317-1782/20152014117

Cited by 4 publications

(1 citation statement)

References 23 publications

(37 reference statements)

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“…Traditionally, a 226 Hz probe tone has been used but researchers have found that using a highfrequency probe tone (>800 Hz) to be more effective in neonates because the ASR is present more often in normal ears at lower activation levels (De Lyra-Silva, Sanches, Neves-Lobo, Ibidi, & Carvallo, 2015;Jacob-Corteletti et al, 2015;Mazlan, Kei, & Hickson, 2009a;Weatherby & Bennett, 1980). An activating tone of 2000 Hz or BBN has been recommended for testing neonates (De Lyra-Silva et al,…”

Section: Acoustic Stapedial Reflexesmentioning

confidence: 99%

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Myers¹

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Background. Infants with early onset of otitis media have greater risk of recurrent and chronic infections that can affect language and development. Diagnostic tools able to quickly and accurately identify middle ear pathology early in infancy could help to facilitate timely intervention for these children.Wideband acoustic immittance (WAI) is an emerging technology for assessing middle ear function with significant advantages over established clinical tests such as tympanometry. WAI does not require pressurization of the ear canal, and is a high-resolution test, measuring middle ear function over a wider frequency range than is possible with tympanometry. Preliminary studies in infants have shown promising results, but further research assessing the diagnostic performance of WAI is needed. Also, the large amount of data generated by WAI can make results difficult to interpret. Research into suitable quantitative techniques to analyse results is still in its infancy. Prediction models are an attractive method for analysis of multivariate data as they can provide individualized probabilities that an infant has middle ear dysfunction. A clinically useful prediction model must be able to accurately discriminate between normal ears and those with middle ear dysfunction, and be well calibrated (i.e., give accurate predictions). However, the number of variables generated by WAI can cause issues with overfitting when developing multivariate models. An overfitted model will accurately describe the data it was developed on, but is likely to perform poorly when applied to new samples. Some form of data reduction or penalization is therefore necessary when modelling WAI. Another issue with developing WAI models is that there are substantial maturational effects on WAI through infancy that need to be controlled for. This can be achieved by either developing models for specific age groups (e.g., a model specifically for neonates), or by controlling for the effect of age by including interactions between age and WAI variables in a model, or by only using developmentally stable regions as predictor variables.Objective. The aim of this work was to investigate the diagnostic performance of WAI in infants by developing predictive models. Data reduction strategies such as selecting predictors based on prior research and principal component analysis were used to increase the likelihood that models would generalize to new samples. The effect of age was initially accounted for by developing age-specific models for neonates, 6-month infants, and 12-month infants (Chapters 2, 3 and 4, respectively). Longitudinal developmental effects on WAI through infancy were then investigated in Chapter 5, and this knowledge was used to develop a model controlling for the effect of age through infancy (6 to 18 months) (Chapter 6, Study 1). The neonate model was assessed for generalizability by applying the model to results from a new sample of infants (Chapter 6, Study 2)ii Methods. Tympanometry, distortion product otoacoustic emissions (DPOAEs) and ...

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Section: Acoustic Stapedial Reflexesmentioning

confidence: 99%

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Myers¹

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Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies

Pohl

Paasche

Lenarz

et al. 2016

International Journal of Audiology

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Effect of Probe-Tone Frequency on Ipsilateral and Contralateral Electrical Stapedius Reflex Measurement in Children With Cochlear Implants

et al. 2019

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Objectives: The upper loudness limit of electrical stimulation in cochlear implant patients is sometimes set using electrically elicited stapedius reflex thresholds (eSRTs), especially in children for whom reporting skills may be limited. In unilateral cochlear implant patients, eSRT levels are measured typically in the contralateral unimplanted ear because the ability to measure eSRTs in the implanted ear is likely to be limited due to the cochlear implant surgery and consequential changes in middle ear dynamics. This practice is particularly limiting in the case of fitting bilaterally implanted pediatric cases because there is no unimplanted ear option to choose for eSRT measurement. The goal of this study was to identify an improved measurement protocol to increase the success of eSRT measurement in ipsilateral or contralateral or both implanted ears of pediatric cochlear implant recipients. This work hypothesizes that use of a higher probe frequency (e.g., 1000 Hz compared with the 226 Hz standard), which is closer to the mechanical middle ear resonant frequency, may be more effective in measuring middle ear muscle contraction in either ear. Design: In the present study, eSRTs were measured using multiple probe frequencies (226, 678, and 1000 Hz) in the ipsilateral and contralateral ears of 19 children with unilateral Advanced Bionics (AB) cochlear implants (mean age = 8.6 years, SD = 2.29). An integrated middle ear analyzer designed by AB was used to elicit and detect stapedius reflexes and assign eSRT levels. In the integrated middle ear analyzer system, an Interacoustics Titan middle ear analyzer was used to perform middle ear measurements in synchrony with research software running on an AB Neptune speech processor, which controlled the delivery of electrical pulse trains at varying levels to the test subject. Changes in middle ear acoustic admittance following an electrical pulse train stimulus indicated the occurrence of an electrically elicited stapedius reflex. Results: Of the 19 ears tested, ipsilateral eSRTs were successfully measured in 3 (16%), 4 (21%), and 7 (37%) ears using probe tones of 226, 678, and 1000 Hz, respectively. Contralateral eSRT levels were measured in 11 (58%), 13 (68%), and 13 (68%) ears using the three different probe frequencies, respectively. A significant difference was found in the incidence of successful eSRT measurement as a function of probe frequency in the ipsilateral ears with the greatest pair-wise difference between the 226 and 1000 Hz probe. A significant increase in contralateral eSRT measurement success as a function of probe frequency was not found. These findings are consistent with the idea that changes in middle ear mechanics, secondary to cochlear implant surgery, may interfere with the detection of stapedius muscle contraction in the ipsilateral middle ear. The best logistic, mixed-effects model of the occurrence of successful eSRT measures included ear of measurement and probe frequency as significant fixed effects. No significant differences in average eSRT levels were observed across ipsilateral and contralateral measurements or as a function of probe frequency. Conclusion: Typically, measurement of stapedius reflexes is less successful in the implanted ears of cochlear implant recipients compared with measurements in the contralateral, unimplanted ear. The ability to measure eSRT levels ipsilaterally can be improved by using a higher probe frequency.

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Acoustic reflex on newborns: the influence of the 226 and 1,000 Hz probes

Cited by 4 publications

References 23 publications

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies

Effect of Probe-Tone Frequency on Ipsilateral and Contralateral Electrical Stapedius Reflex Measurement in Children With Cochlear Implants

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