AudiologyOnline Phone: 800-753-2160


CapTel Reconnect - December 2022

Norms on Bone Conduction Tone Burst ABR

Roanne Karzon, PhD, CCC-A

August 15, 2005

Share:

Question

Do you have any normative data on bone conduction tone burst ABR by frequency (500, 2,4k Hz) for diagnosing hearing loss in newborns? I need to build our own norms, but would like to see what others have found. I would like collection parameters also.

Answer

Before you administer bone-conduction ABR stimuli, you will need to establish dBnHL for the stimuli you plan to use. This process will need to be done with 10 to 20 older children and/or adults. The transduction characteristics of infant heads are different from older children and adults. However, if you couple the bone-conduction transducer with 400 to 450 g of force, you will be appropriate. Several reports suggest the use of a headband and a spring scale. We (and others) have found that carefully positioning the metal headband seems to work well. You can use a folded washcloth to cover the band ending opposite to the bone vibrator to cushion the head. Others use a headband or handheld placement. The handheld placement is difficult because the variability in pressure throughout the measure may obscure results. You can make measures of click stimuli or toneburst stimuli. A set of parameters that you might try is as follows:

Bone Conduction Clicks: B-70 oscillator, click duration of 0.1ms, ramping (windowing) is transient, maximum intensity will be between 40 to 55 dB nHL, alternating polarity, rate of 11.1 per second, Filters from 30 to 3000 Hz, time window of 15 ms, number of sweeps is dependent on signal to noise ratio. For frequency stimuli a 2-1-2 toneburst (2 cycle rise, 1 cycle plateau, 2 cycle fall) with rarefaction has worked for us. We have had success in measuring cochlear reserve in infants with middle ear pathology and aural atresia, etc. We have found it difficult to establish clinically effective masking levels. If you see wave I, you know which ear is being stimulated. Another technique for determining the test ear is to compare the wave V latency for the ipsilateral and contralateral traces. The wave V amplitudes should be larger in the ipsilateral channel relative to the contralateral channel. If you are interested, an alternative approach is with SAL (sensorineural acuity level). With SAL, the efficiency of a bone-conducted noise in masking an air-conducted stimulus is used to estimate sensory-neural reserve. We have not used SAL at our institution.

Roanne K. Karzon, Ph.D. CCC-A has been an audiologist for 27 years. She is the Manager of Audiology at St. Louis Children's Hospital and resides in St. Louis, Missouri. She can be reached at roannekk@bjc.org


Roanne Karzon, PhD, CCC-A


Related Courses

Improving EHDI with CAEPs: Clinical Assessment of the Cortical Auditory Evoked Potential in Children with Hearing Loss
Presented by Elizabeth Musgrave, AuD, CCC-A
Recorded Webinar
AudiologyOnline

Presenter

Elizabeth Musgrave, AuD, CCC-A
Course: #31492Level: Intermediate1 Hour
  'Very pragmatic presentation regarding the clinical applications of cortical auditory evoked potentials and the value in using this procedure for the assessment of infants and children'   Read Reviews
This course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Simple and Evidence-Based ABR Protocol for Infant Hearing Assessment
Presented by James Hall, PhD
Recorded Webinar
Natus

Presenter

James Hall, PhD
Course: #33939Level: Intermediate1 Hour
  'Easy to understand and follow along with a more complex subject area'   Read Reviews
This presentation offers practical evidence-based information on auditory brainstem response (ABR) that can be applied clinically in the accurate diagnosis of infant auditory dysfunction. The presentation reviews test parameters and protocols for efficient single channel air- and bone-conduction ABR measurement plus the role of auditory steady state response (ASSR). Strategies and technical advances are described for performing a complete frequency-specific ABR assessment in 30 minutes or less, and combining ABR with other objective auditory procedures (otoacoustic emissions and aural immittance measurement), for successful infant hearing assessment in natural sleep.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Infant ABR: Protocols, Diagnosis, and Intervention, presented in partnership with Cincinnati Children's
Presented by Sara Kallini, AuD, Erin Pinsky, AuD, CCC-A
Recorded Webinar
AudiologyOnline

Presenters

Sara Kallini, AuDErin Pinsky, AuD, CCC-A
Course: #28052Level: Intermediate1.5 Hours
  'I felt it was a great foundational refresher with updates to teach me new things'   Read Reviews
This course discusses clinical applications of infant ABR from diagnosis to intervention in a pediatric hospital setting. This webinar will include an overview of protocols, populations, equipment, and a wide variety of case studies. This course is presented in partnership with Cincinnati Children's.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Update on Auditory Evoked Responses: Evidence-Based ABR Protocol for Infant Hearing Assessment
Presented by James W. Hall III, PhD
Recorded Webinar
AudiologyOnline

Presenter

James W. Hall III, PhD
Course: #27299Level: Intermediate1 Hour
  'Good explanation of the testing parameters of ABR for infant hearing screening'   Read Reviews
A clinically feasible and effective protocol for infant hearing assessment with ABR is described. Research findings support all recommended stimulus and acquisition parameters. This course is open captioned.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of the course 27890.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Update on Auditory Evoked Responses: Value of Chirp Stimuli in ABR/ASSR Measurement
Presented by James W. Hall III, PhD
Recorded Webinar
AudiologyOnline

Presenter

James W. Hall III, PhD
Course: #27300Level: Intermediate1 Hour
  'THe examples shown the chirp evoked ABR wave V and how they compare to click evoked ABR waveforms'   Read Reviews
In this course chirp stimuli are described and their rationale for clinical application is discussed. Data are presented in support of the use of chirp versions of click and tone burst stimuli in ABR and ASSR assessment of infants and young children. This course is open captioned.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of the course 27885, "Auditory Evoked Responses for Infant Hearing Assessment Series". Course 27885 contains recordings of all three events from our 2016 series on Auditory Evoked Responses for Infant Hearing Assessment. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 27885.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.