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Permanent Childhood Hearing Loss
Audiologic Assessment

Auditory Steady State Response (ASSR)



External Scientific Evidence

Evidence-Based Practice Guidelines
No evidence-based practice guidelines were found.

Evidence-Based Systematic Reviews
Diagnostic Challenges and Safety Considerations in Cochlear Implantation Under the Age of 12 Months
Vlastarakos, P. V., Candiloros, D., et al. (2010).
International Journal of Pediatric Otorhinolaryngology, 74(2), 127-32.
Added: July 2012

This is a systematic review of the literature examining the diagnostic, surgical, and anesthetic challenges associated with cochlear implantation in children before the age of 12 months.

  • “Visual reinforcement audiomentry (VRA) which may be used for behavioral testing in late infancy, is not applicable in young infants, due to their inability to make reliable direct head-turn responses towards sound sources. In addition, children with additional disorders as well as prematurity may also not be able to complete VRA testing. Objective audiometric tests (OAE, ABR, and ASSR) may be the only method of assessing candidacy for early cochlear implantation…” (p. 128).

  • “ASSRs are a relatively recent method which shows better specificity in various frequencies compared to ABRs. They are also more objective, as they relate the prediction of an auditory response to statistical criteria, which are incorporated in their software, and not to the examiner’s level of expertise” (p. 128).

  • “ASSR thresholds determined in infancy have been found to highly correlate to behavioural hearing levels obtained later in childhood, both for children with normal hearing and for sufferers of varying degrees of sensorineural hearing loss. They seem however at least partially affected by the maturational development during the first weeks of life, thus demonstrating variable results across subjects during this period. Hence postponement of the examination, until after the immediate neonatal period may be required” (p. 128).

  • “When a variable recording length [of ASSR] is allowed, the acceptance criterion of the statistical test needs adjustments in order to ensure a tolerable error rate” (p. 128).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
American Academy of Audiology

Audiologic Guidelines for the Assessment of Hearing in Infants and Young Children
Retrieved from
Added: May 2013

This guideline provides recommendations for the assessment of auditory function in infants and young children. The target audience of this guideline is audiologists. Select recommendations are provided below; for the full set of recommendations, please review the guideline document.


  • A pediatric audiologic assessment test battery includes a case history, otoscopy, behavioral observation, visual reinforcement audiometry, conditioned play audiometry, physiologic assessments (e.g., tympanometry, otoacoustic emission testing), and electrophysiologic audiometry (e.g., auditory brainstem response, auditory steady state response).

  • ASSR is used to estimate ear- and frequency-specific hearing levels and determine type of hearing loss.

  • ASSR testing can be used for newborns and infants or children (of any age) who are unable to provide accurate or reliable responses to behavioral testing.

  • For ASSR testing, "it is imperative that children sleep soundly for a prolonged period of time, to obtain clean, low-noise electrophysiologic recordings. Natural sleep is best but when this cannot be assured, sedation is necessary" (p. 44).

  • Middle ear effusion (MEE) is not a contraindication to testing and testing should not be delayed due to MEE.

  • If no ASSR thresholds are within normal limits, the child should be assessed for auditory neuropathy spectrum disorder.

  • "ASSR in infants should be elicited using modulation rates between 75 and 110 Hz" (p. 46).

  • Because of the increased likelihood of detecting stimulus artifact with an automated analysis, ASSR should not be used to measure bone conduction thresholds.

  • "Correction factors are typically applied to ASSR thresholds in order to estimate behavioral hearing levels" (p. 48).

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Joint Committee on Infant Hearing

Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs
Joint Committee on Infant Hearing (2007).
Pediatrics, 120(4), 898-921.
Added: July 2012

This consensus-based guideline provides recommendations for screening infants for hearing loss, assessing infants identified as at-risk for hearing impairment, and providing appropriate early intervention for infants with hearing impairment. The intended audience of these guidelines is not specified, however they are relevant to all professionals involved in the screening, assessment or treatment of hearing in infants.

“There is insufficient evidence for the use of auditory steady state response as the sole measure of auditory status in newborn and infant populations” (p. 14).

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NHS Newborn Hearing Screening Programme Clinical Group (UK)

Newborn Hearing Screening and Assessment: Guidelines for the Early Audiological Assessment and Management of Babies Referred from the Newborn Hearing Screening Programme
Stevens, J., Sutton, G., et al. (2011).
England: NHS Newborn Hearing Screening Programme Clinical Group, 41 pages.
Added: July 2012

This consensus-based guideline provides recommendation for the early audiologic assessment of infants referred from the newborn hearing screening program.


  • “ASSR [auditory steady state response] is a promising technique and its implementation in most current clinical equipment enables simultaneous testing of both ears at multiple frequencies, although there are limitations to this at high stimulus levels. This enables more frequency specific thresholds to be measured in a given test time. However the consensus at present is that it should not be used alone for assessment of hearing in babies who have an elevated threshold” (p. 9).

  • ASSR may be used in conjunction with tone pip ABR.

  • An audiologic assessment should include the following:

    • OAEs

    • Air conduction tone pip ABR

    • Bone conduction ABR

    • ASSR

    • Tympanometry – A high frequency probe tone of 1 kHz should always be used for babies less than 6 months of age.

    • Reactions to stimuli.

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Client/Patient/Caregiver Perspectives

No information was found pertaining to client/patient/caregiver perspectives.

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