Clin Exp Otorhinolaryngol.  2008 Dec;1(4):184-188.

Clinical Comparison of the Auditory Steady-State Response with the Click Auditory Brainstem Response in Infants

  • 1Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.


Our goal was to determine the effectiveness of using the auditory steady state response (ASSR) as a measure of hearing thresholds in infants who are suspected of having significant hearing loss, as compared with using the click-auditory brainstem response (C-ABR). METHODS: We retrospectively analyzed the audiologic profiles of 76 infants (46 boys and 30 girls, a total of 151 ears) who ranged in age from 1 to 12 months (average age: 5.7 months). The auditory evaluations in 76 infants who were suspected of having hearing loss were done via the C-ABR and ASSR. In addition, for reference, the mean ASSR thresholds were compared to those of 39 ears of infants and 39 ears of adults with normal hearing at 0.5, 1, 2, and 4 kHz. RESULTS: The highest correlation between the C-ABR and ASSR thresholds was observed at an average of 2-4 kHz (r=0.94). On comparison between the hearing of infants and adults at 0.5, 1, 2, and 4 kHz, the mean ASSR threshold in infants was 12, 7, 8, and 7 dB higher, respectively, than that in adults. CONCLUSION: ASSR testing may provide additional audiometric information for accurately predicting the hearing sensitivity, and this is essential for the management of infants with severe to profound hearing loss.


Click evoked response audiometry; Auditory steady-state response; Auditory brain stem response; Auditory threshold; Hearing

MeSH Terms

Auditory Threshold
Brain Stem
Evoked Potentials, Auditory, Brain Stem
Hearing Loss
Retrospective Studies


  • Fig. 1 (A) The presence and absence of responses to ASSR and C-ABR for each ear. (B) Analysis of 77 ears with ASSR responses at 1 or more steady-state frequencies. The distribution of the responses was mainly at the level of 90-110 dBHL.ASSR: auditory steady state response; C-ABR: click-auditory brainstem response.

  • Fig. 2 Scatterplots of the ASSR and C-ABR thresholds at 2 and 4 kHz and the average of the 2 and 4 kHz thresholds.ASSR: auditory steady state response; C-ABR: click-auditory brainstem response.


1. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000; 9. 106(3):E43. PMID: 10969127.
2. Vander Werff KR, Brown CJ, Gienapp BA, Schmidt Clay KM. Comparison of auditory steady-state response and auditory brainstem response thresholds in children. J Am Acad Audiol. 2002; 5. 13(5):227–235. quiz 83-4. PMID: 12120715.
3. Kennedy C, McCann D. Universal neonatal hearing screening moving from evidence to practice. Arch Dis Child Fetal Neonatal Ed. 2004; 9. 89(5):F378–F383. PMID: 15321952.
4. Kemp DT, Ryan S, Bray P. A guide to the effective use of otoacoustic emissions. Ear Hear. 1990; 4. 11(2):93–105. PMID: 2340969.
5. Eggermont JJ. The inadequacy of click-evoked auditory brainstem responses in audiological applications. Ann N Y Acad Sci. 1982; 388:707–709. PMID: 6953905.
6. Durieux-Smith A, Picton TW, Bernard P, MacMurray B, Goodman JT. Prognostic validity of brainstem electric response audiometry in infants of a neonatal intensive care unit. Audiology. 1991; 30(5):249–265. PMID: 1793386.
7. Brookhouser PE, Gorga MP, Kelly WJ. Auditory brainstem response results as predictors of behavioral auditory thresholds in severe and profound hearing impairment. Laryngoscope. 1990; 8. 100(8):803–810. PMID: 2381254.
8. Rance G, Dowell RC, Rickards FW, Beer DE, Clark GM. Steady-state evoked potential and behavioral hearing thresholds in a group of children with absent click-evoked auditory brain stem response. Ear Hear. 1998; 2. 19(1):48–61. PMID: 9504272.
9. Maiste A, Picton T. Human auditory evoked potentials to frequency-modulated tones. Ear Hear. 1989; 6. 10(3):153–160. PMID: 2744250.
10. Stapells DR, Linden D, Suffield JB, Hamel G, Picton TW. Human auditory steady state potentials. Ear Hear. 1984; Mar–Apr. 5(2):105–113. PMID: 6724170.
11. Picton TW, Skinner CR, Champagne SC, Kellett AJ, Maiste AC. Potentials evoked by the sinusoidal modulation of the amplitude or frequency of a tone. J Acoust Soc Am. 1987; 7. 82(1):165–178. PMID: 3624637.
12. Cohen LT, Rickards FW, Clark GM. A comparison of steady-state evoked potentials to modulated tones in awake and sleeping humans. J Acoust Soc Am. 1991; 11. 90(5):2467–2479. PMID: 1774415.
13. Aoyagi M, Kiren T, Kim Y, Suzuki Y, Fuse T, Koike Y. Optimal modulation frequency for amplitude-modulation following response in young children during sleep. Hear Res. 1993; 2. 65(1-2):253–261. PMID: 8458756.
14. Firszt JB, Gaggl W, Runge-Samuelson CL, Burg LS, Wackym PA. Auditory sensitivity in children using the auditory steady-state response. Arch Otolaryngol Head Neck Surg. 2004; 5. 130(5):536–540. PMID: 15148173.
15. Luts H, Desloovere C, Wouters J. Clinical application of dichotic multiple-stimulus auditory steady-state responses in high-risk newborns and young children. Audiol Neurootol. 2006; 11(1):24–37. PMID: 16219992.
16. Lins OG, Picton TW, Boucher BL, Durieux-Smith A, Champagne SC, Moran LM, et al. Frequency-specific audiometry using steady-state responses. Ear Hear. 1996; 4. 17(2):81–96. PMID: 8698162.
17. Rance G, Rickards F. Prediction of hearing threshold in infants using auditory steady-state evoked potentials. J Am Acad Audiol. 2002; 5. 13(5):236–245. PMID: 12120716.
18. Cone-Wesson B, Rickards F, Poulis C, Parker J, Tan L, Pollard J. The auditory steady-state response: clinical observations and applications in infants and children. J Am Acad Audiol. 2002; 5. 13(5):270–282. PMID: 12120719.
19. Savio G, Cardenas J, Perez Abalo M, Gonzalez A, Valdes J. The low and high frequency auditory steady state responses mature at different rates. Audiol Neurootol. 2001; Sep–Oct. 6(5):279–287. PMID: 11729330.
20. Rickards FW, Tan LE, Cohen LT, Wilson OJ, Drew JH, Clark GM. Auditory steady-state evoked potential in newborns. Br J Audiol. 1994; 12. 28(6):327–337. PMID: 7757032.
21. Keefe DH, Levi E. Maturation of the middle and external ears: acoustic power-based responses and reflectance tympanometry. Ear Hear. 1996; 10. 17(5):361–373. PMID: 8909884.
22. Stueve MP, O'Rourke C. Estimation of hearing loss in children: comparison of auditory steady-state response, auditory brainstem response, and behavioral test methods. Am J Audiol. 2003; 12. 12(2):125–136. PMID: 14964328.
Full Text Links
  • CEO
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: