Rapid Acquisition of the Frequency-Specific Auditory Brainstem Response Through Parallel Stimulus Presentation

Project Summary/Abstract The auditory brainstem response (ABR) is an essential tool in diagnosing infant hearing loss, and its results drive decisions regarding interventions and hearing habilitation with impacts extending far into a child’s future. Despite the traditional ABR exam’s usefulness, there is an identified need to develop faster, more informative exams. The overall goal of this proposal is to transform paradigms for ABR hearing assessment using advanced stimulus design and signal processing tools. We have developed and validated in adults the parallel ABR (pABR), which measures responses to all frequencies of interest in both ears all at once, rather than the traditional series of single-frequency measurements in one ear at a time. The pABR provides waveforms and estimates thresholds over twice as fast as serial ABR measurement and predicts hearing loss with very high accuracy in adults. The pABR’s speed is critical, as diagnostic ABR exams are typically performed while an infant sleeps, limiting their length to that of an unpredictable—and often short—nap. Aim 1 of this proposal is to validate the accuracy of the pABR in infants by comparing it to current ABR methods. We will estimate hearing thresholds using the pABR in young infants with hearing loss and compare them to measurements made with standard serial ABR methods. In Aim 1a we will test air conduction thresholds. In Aim 1b we will test bone conduction thresholds, which are critical for diagnosing conductive hearing loss. In Aim 2 we will measure pABR thresholds in infants aged 8–14 months and compare them to gold standard behavioral thresholds using visual response audiometry. We will also establish pABR-behavioral stimulus level conversion factors for both air and bone conduction, allowing the pABR to be included in commercial devices and deployed in the clinic. Aim 3 is to leverage a powerful denoising algorithm that we have developed to allow rapid collection of pABR responses without the need to interactively guide the exam. In radiology and other fields, technicians perform tests, freeing the expert to focus on making a diagnosis and consulting with the patient. With rapid, automatic collection of all response waveforms—something never before possible—a technician could run the pABR test and provide the results to an audiologist, potentially at another site, for later diagnosis and consultation. Such a paradigm would open new avenues for healthcare delivery to rural, low-income, and other underserved areas. We will test this tool in adults (Aim 3a) and then infants (Aim 3b) with hearing loss. The pABR is an innovative paradigm that, combined with our advanced denoising tools, could lead to substantial improvements in hearing loss diagnosis. These improvements will facilitate timely and accurate diagnosis that will impact thousands of infants and families each year.