Pressurized Wideband Acoustic Stapedial Reflex Thresholds: Normal Development and Relationships to Auditory Function in Infants

This study analyzed effects of pressurization on wideband acoustic stapedial-muscle reflex (ASR) tests in infants cared for in normal newborn (NN) and neonatal intensive care units (NICU). Effects of hearing-screening outcomes on ASR threshold measurements were also evaluated, and a subsequent longitudinal study established normative threshold ranges over the first year after birth. An initial experiment compared thresholds in newborns measured at ambient pressure in the ear canal and at the tympanometric peak pressure. ASR thresholds for broadband noise were higher for ears that did not pass newborn hearing screening and ASR threshold was 14 dB higher for real-ear compared to coupler conditions. Effects of pressurization were significant for ears that passed screening; thus, ASR testing in infants should be conducted at tympanometric peak pressure. ASR threshold was significantly higher for ears that referred on transient evoked otoacoustic emissions and Auditory Brainstem Response (ABR) screening tests and also for ears with conductive and sensorineural hearing loss diagnosed by ABR. Developmental ASR changes were significant over the first year for both normal and NICU infants. Wideband pressurized ASR thresholds are a clinically relevant measure of newborn hearing screening and diagnostic outcomes.