A validation and normative study of the Parents' Evaluation of Aural/Oral Performance of Children plus (PEACH+) rating scale in Malaysia.

OBJECTIVE: The purpose of the present study was to (1) translate and validate the PEACH + Rating Scale in Malay and (2) establish normative curves as a function of age and examine test-retest reliability for the Malay and English versions of PEACH+. DESIGN: This is a cross-sectional study that used a convenient sampling technique. STUDY SAMPLE: One hundred and fifty-seven parents of typically developing children aged between 4 months and 7 years participated in the study. Forty-nine completed the Malay PEACH + in a pen-to-paper format (Aim 1). One hundred and eight parents completed PEACH + online (69 completed the Malay version and 39 the English version), and 20 of them completed the questionnaire twice (Aim 2). RESULTS: The PEACH + in Malay showed high internal consistency and item-total correlation. The normative data revealed that scores for frequency of auditory behaviour increased rapidly with age until about 20 months and reached an asymptote of around 90% by about 40 months of age. A similar trend was observed for ease of listening scores, which asymptoted around 85%. CONCLUSIONS: The validated Malay PEACH + Rating Scale can be used as a guide to monitor auditory functional performance and listening efforts of Malaysian children in real-world environments.

Reliability and Accuracy of Chirp Based Multiple Auditory Steady State Response (MSSR) and Auditory Brainstem Response (ABR) in Children.

OBJECTIVE: The purpose of this study was to compare the reliability and accuracy of chirp-based Multiple Auditory Steady State Response (MSSR) and Auditory Brainstem Response (ABR) in children. METHODS: The prospective clinical study was conducted at Selayang Hospital (SH) and Hospital Canselor Tuanku Muhriz (HCTM) within one year. A total of 38 children ranging from 3 to 18 years old underwent hearing evaluation using ABR tests and MSSR under sedation. The duration of both tests were then compared. RESULTS: The estimated hearing threshold of frequency specific chirp MSSR showed good correlation with ABR especially in higher frequencies such as 2000 Hz and 4000Hz with the value of cronbach alpha of 0.890, 0.933, 0.970 and 0.969 on 500Hz, 1000Hz, 2000Hz and 4000Hz. The sensitivity of MSSR is 0.786, 0.75, 0.957 and 0.889 and specificity is 0.85, 0.882, 0.979 and 0.966 over 500Hz, 1000Hz, 2000Hz and 4000Hz. The duration of MSSR tests were shorter than ABR tests in normal hearing children with an average of 35.3 minutes for MSSR tests and 46.4 minutes for ABR tests. This can also be seen in children with hearing loss where the average duration for MSSR tests is 40.0 minutes and 52.0 minutes for ABR tests. CONCLUSION: MSSR showed good correlation and reliability in comparison with ABR especially on higher frequencies. Hence, MSSR is a good clinical test to diagnose children with hearing loss.

Knowledge and attitudes of primary care physicians regarding childhood hearing loss in Malaysia.

BACKGROUND: Childhood hearing loss is a significant health concern. Early identification and intervention are essential to maximize hearing potential and developmental outcomes, with primary care physicians (PCPs) playing a pivotal role in this process. OBJECTIVES: This study aimed to assess PCPs' knowledge and attitudes toward childhood hearing loss, investigate the association between knowledge and attitudes, and examine the influence of demographic factors on PCPs' knowledge and attitudes towards childhood hearing loss. METHODS: This cross-sectional study was conducted from 30 November 2017 to 30 July 2018 at three public health clinics in Malaysia, specifically in the Federal Territory of Kuala Lumpur, Selangor, and Terengganu. A self-administered questionnaire assessed PCPs' knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated PCPS' attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss. RESULTS: Most participants lacked sufficient knowledge about childhood hearing loss, with 61.4% not seeing it as a major health issue. Almost half (45.9%) didn't know that children with hearing loss can succeed in regular schools, and 78% were unaware that hearing aids don't fully restore normal hearing. Participants' awareness of risk factors varied widely, ranging from 24.6% to 90.3%. Despite these knowledge gaps, participants generally had positive attitudes towards childhood hearing loss, especially in cognitive and behavioural aspects. The study found a strong positive link between knowledge and attitudes, but demographic factors didn't significantly affect them. CONCLUSIONS: This study highlights the urgent need to address knowledge gaps among Malaysian PCPs regarding childhood hearing loss. While these knowledge gaps exist, PCPs' positive attitudes form a foundation for developing targeted educational interventions to improve PCPs' knowledge and skills in managing childhood hearing loss. Collaborative efforts are essential to translate these findings into meaningful improvements in paediatric audiological care.

Development of the Mandarin Nonsense Word Identification Test.

OBJECTIVE: This study aimed to develop a digitised Mandarin Nonsense Word Speech Perception Test for use in Malaysia, a multilingual country in Southeast Asia. DESIGN: In Phase I, 400 vowel-consonant-vowel (VCV) nonsense word samples containing 20 Mandarin consonants in /a/, /i/, or /u/ contexts were recorded from two speakers of different genders. Acoustic analyses, sound quality ratings, and item validations were used to guide selection of items to form two gender-specific test lists. In Phase II, performance-intensity functions and test-retest reliability for the lists were established. STUDY SAMPLE: Native Mandarin-speaking adults with normal hearing participated in Phase I (n = 10) and Phase II (n = 69). RESULTS: Eighty-four of the 400 VCV words were selected to form two gender-specific test lists. A two-way repeated measure ANOVA revealed a significant interaction effect between speaker-gender and presentation level [F (4.88, 283.20) = 22.79, p < 0.001, ηp2= 0.28]. Intraclass correlation scores of 0.75 and 0.87 were obtained for the female-speaker and male-speaker lists respectively. CONCLUSIONS: The preliminary normative data of the Mandarin nonsense word test have been developed. It is recommended to use separate gender-specific norms when conducting the test. The test has good validity and reliability for testing Mandarin-speaking adults in Malaysia.

Quality measures of a multicentre universal newborn hearing screening program in Malaysia.

OBJECTIVE: To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia. METHOD: A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated. RESULTS: Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016. CONCLUSIONS: Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.

Knowledge and attitude on childhood hearing loss among mothers and mothers-to-be in urban and rural areas in Malaysia.

OBJECTIVES: Maternal knowledge and attitude towards childhood hearing loss play an important role in determining the success of early diagnosis and intervention of hearing loss programs in children. This study aimed to 1) assess the knowledge and attitude of childhood hearing loss among mothers, 2) compare knowledge and attitude of childhood hearing loss in urban and rural mothers, 3) investigate the relationship between knowledge and attitude on childhood hearing loss, and 4) identify socio-demographic factors that influence mothers' knowledge and attitude on childhood hearing loss. METHOD: A cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ±â€¯4.9 years, range: 20-48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss. RESULTS: Generally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p < 0.05). However, no significant differences were observed in attitude toward childhood hearing loss between urban and rural mothers. In addition, there was no significant relationship found between knowledge and attitude on childhood hearing loss among mothers. Age, race, occupation and education level contributed to the knowledge score significantly (p < 0.05), whereas, only race was significantly associated with attitude. CONCLUSION: In spite of positive attitude towards childhood hearing loss, the majority of mothers and mothers-to-be demonstrated poor knowledge on this aspect. Therefore, this study highlights the urgent need to develop and implement appropriate health education campaigns to improve mothers' knowledge of childhood hearing loss.

A Longitudinal Analysis of Pressurized Wideband Absorbance Measures in Healthy Young Infants.

OBJECTIVES: Wideband absorbance (WBA) is an emerging technology to evaluate the conductive pathway (outer and middle ear) in young infants. While a wealth of research has been devoted to measuring WBA at ambient pressure, few studies have investigated the use of pressurized WBA with this population. The purpose of this study was to investigate the effect of age on WBA measured under pressurized conditions in healthy infants from 0 to 6 months of age. DESIGN: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age. RESULTS: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies (<0.4 kHz) and increased at high frequencies (2 to 5and 8 kHz) with age. Specifically, WBA measured at TPP and 0 daPa in 3- to 6-month-olds was significantly different from that of 0- to 2-month-olds at low (0.25 to 0.31 kHz) and high (2 to 5 and 8 kHz) frequencies. However, there were no significant differences between WBA measured at TPP and 0 daPa for infants from 3 to 6 months of age. CONCLUSIONS: The present study provided clear evidence of maturation of the outer and middle ear system in healthy infants from birth to 6 months. Therefore, age-specific normative data of pressurized WBA are warranted.

Development and evaluation of a hearing aid manual in the Malay language.

OBJECTIVE: This study aimed to (a) translate a hearing aid (HA) manual into Malay language and revise the translated manual based on best practice guidelines; (b) compare the effectiveness of the translated and the revised Malay HA manuals in helping individuals to perform HA management tasks. DESIGN: Cross-sectional, randomised, single-blinded study. STUDY SAMPLE: An Oticon-Dynamo HA manual was translated and revised based on best practice guidelines. Ninety participants aged 55 years and above participated in this study. They were randomly assigned into the control group (received translated manual) and the experimental group (received the revised translated manual). The Hearing Aid Management (HAM) test, which was developed in a previous study, was conducted to evaluate participant's ability to perform HA management tasks using the translated and the revised version of Malay HA manual. RESULTS: The revised Malay HA manual had a lower reading grade level relative to the initial translated Malay HA manual. The ability to perform HA management tasks was better in the experimental group (mean = 12.2, SD = 1.15) versus the control group (mean = 8.7, SD = 2.11). CONCLUSION: Further revision of existing HA manuals based on best practice guidelines is recommended to help individuals better manage their HAs.

Parenting Stress and Maternal Coherence: Mothers With Deaf or Hard-of-Hearing Children.

PURPOSE: The aim of this study was to develop a substantive theory that explains parenting stress among mothers of deaf or hard-of-hearing (D/HH) children. METHOD: Fifteen hearing mothers of children with severe-to-profound sensorineural hearing loss were interviewed. Interviews were transcribed verbatim, and a grounded theory approach was used to inductively analyze parental stress in mothers of D/HH children. Theory generation was achieved through triangulation of data sources and systematic organization of data into codes. The coding process identified salient themes that were constantly cross-checked and compared across data to further develop categories, properties, and tentative hypotheses. RESULTS: In general, two main themes emerged from the interviews: the contextual stressors and stress-reducing resources. The contextual stressors were labeled as distress over audiology-related needs, pressure to acquire new knowledge and skills, apprehension about the child's future, and demoralizing negative social attitudes. The stress-reducing resources that moderated parenting stress were identified to be the child's progress, mother's characteristics, professional support, and social support. The interaction between the identified stressors and adjustment process uncovered a central theme termed maternal coherence. CONCLUSION: The substantive theory suggests that mothers of D/HH children can effectively manage parenting stress and increase well-being by capitalizing on relevant stress-reducing resources to achieve maternal coherence.

The Effect of Ethnicity on Wideband Absorbance of Neonates with Healthy Middle Ear Functions in Malaysia: A Preliminary Study.

BACKGROUND AND OBJECTIVES: Although ethnicity effect on wideband absorbance (WBA) findings was evident for adults, its effect on neonates has not been established yet. This study aimed to investigate the influence of ethnicity on WBA measured at 0 daPa from neonates with healthy middle ear functions. SUBJECTS AND METHODS: Participants were 99 normal, healthy, full-term newborn babies with chronological age between 11 and 128 hours of age (mean=46.73, standard deviation=26.36). A cross-sectional study design was used to measure WBA at 16 one-third octave frequency points from 99 neonates comprising of three ethnic groups: Malays (n=58), Chinese (n=13) and Indians (n=28). A total of 165 ears (83.3%) that passed a battery of tests involving distortion product otoacoustic emissions, 1 kHz tympanometry and acoustic stapedial reflex were further tested using WBA. Moreover, body size measurements were recorded from each participant. RESULTS: The Malays and Indians neonates showed almost identical WBA response across the frequency range while the Chinese babies showed lower absorbance values between 1.25 kHz and 5 kHz. However, the differences observed in WBA between the three ethnic groups were not statistically significant (p=0.23). Additionally, there were no statistically significant difference in birth weight, height and head circumference among the three ethnic groups. CONCLUSIONS: This study showed that Malays, Chinese and Indians neonates were not significantly different in their WBA responses. In conclusion, to apply for the ethnic-specific norms is not warranted when testing neonates from population constitute of these three ethnicities.

Pressurized Wideband Absorbance Findings in Healthy Neonates: A Preliminary Study.

Purpose: The present study aimed to establish normative data for wideband absorbance (WBA) measured at tympanometric peak pressure (TPP) and 0 daPa and to assess the test-retest reliability of both measurements in healthy neonates. Method: Participants of this cross-sectional study included 99 full-term neonates (165 ears) with mean chronological age of 46.7 hrs (SD = 26.3 hrs). Of the 99 neonates, 58 were Malay, 28 were Indian, and 13 were Chinese. The neonates who passed high-frequency (1 kHz) tympanometry, acoustic stapedial reflex, and distortion product otoacoustic emission screening tests were assessed using a pressurized WBA test (wideband tympanometry). To reduce the number of measurement points, the WBA responses were averaged to 16 one-third octave frequency bands from 0.25 to 8 kHz. A mixed-model analysis of variance was applied to the data to investigate the effects of frequency, ear, gender, and ethnicity on WBA. The analysis of variance was also used to compare between WBA measured at TPP and 0 daPa. An interclass correlation coefficient test was applied at each of the 16 frequency bands to measure the test-retest reliability of WBA at TPP and 0 daPa. Results: Both WBA measurements at TPP and 0 daPa exhibited a multipeaked pattern with 2 maxima at 1.25-1.6 kHz and 6.3 kHz and 2 minima at 0.5 and 4 kHz. The mean WBA measured at TPP was significantly higher than that measured at 0 daPa at 0.25, 0.4, 0.5, 1.25, and 1.6 kHz only. A normative data set was developed for absorbance at TPP and at 0 daPa. There was no significant effect of ethnicity, gender, and ear on both measurements of WBA. The test-retest reliability of WBA at TPP and 0 daPa was high with the interclass correlation coefficient ranging from 0.77 to 0.97 across the frequencies. Conclusions: Normative data of WBA measured at TPP and 0 daPa for neonates were provided in the present study. Although WBA at TPP was slightly higher than the WBA measured at 0 daPa at some frequencies below 2 kHz, the WBA patterns of the 2 measurements were nearly identical. Moreover, the test-retest reliability of both WBA measurements was high.

Effects of tonal language background on tests of temporal sequencing in children.

OBJECTIVE: The aims of the present study were to determine the effects of language background on the performance of the pitch pattern sequence test (PPST) and duration pattern sequence test (DPST). As temporal order sequencing may be affected by age and working memory, these factors were also studied. DESIGN: Performance of tonal and non-tonal language speakers on PPST and DPST were compared. STUDY SAMPLE: Twenty-eight native Mandarin (tonal language) speakers and twenty-nine native Malay (non-tonal language) speakers between seven to nine years old participated in this study. RESULTS: The results revealed that relative to native Malay speakers, native Mandarin speakers demonstrated better scores on the PPST in both humming and verbal labeling responses. However, a similar language effect was not apparent in the DPST. An age effect was only significant in the PPST (verbal labeling). Finally, no significant effect of working memory was found on the PPST and the DPST. CONCLUSION: These findings suggest that the PPST is affected by tonal language background, and highlight the importance of developing different normative values for tonal and non-tonal language speakers.

Age and Gender Effects on Wideband Absorbance in Adults With Normal Outer and Middle Ear Function.

PURPOSE: This study examined the effects of age and gender on wideband energy absorbance in adults with normal middle ear function. METHOD: Forty young adults (14 men, 26 women, aged 20-38 years), 31 middle-aged adults (16 men, 15 women, aged 42-64 years), and 30 older adults (20 men, 10 women, aged 65-82 years) were assessed. Energy absorbance (EA) data were collected at 30 frequencies using a prototype commercial instrument developed by Interacoustics. RESULTS: Results showed that the young adult group had significantly lower EA (between 400 and 560 Hz) than the middle-aged group. However, the middle-aged group showed significantly lower EA (between 2240 and 5040 Hz) than the young adult group. In addition, the older adult group had significantly lower EA than the young adult group (between 2520 and 5040 Hz). No significant difference in EA was found at any frequency between middle-aged and older adults. Across age groups, gender differences were found with men having significantly higher EA values than women at lower frequencies, whereas women had significantly higher EA at higher frequencies. CONCLUSIONS: This study provides evidence of the influence of gender and age on EA in adults with normal outer and middle ear function. These findings support the importance of establishing age- and gender-specific EA norms for the adult population.

A questionnaire-based study on parental satisfaction with a universal newborn hearing screening program in Kuala Lumpur, Malaysia.

OBJECTIVES: The present study aimed to determine levels of parents' satisfaction associated with the universal newborn hearing screening process in a university hospital setting in Kuala Lumpur, Malaysia. METHODS: Parents whose babies had undergone a hearing screening test at the Pusat Perubatan Universiti Kebangsaan (Universiti Kebangsaan Malaysia Medical Center), Kuala Lumpur, Malaysia, participated in this study. In this study, the original English version of the Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program (PSQ-NHSP) was translated and adapted into Malay language. Thus, this self-administered Malay version of PSQ-NHSP was used to measure parents' satisfaction on information of newborn hearing screening program, personnel in charge of the hearing testing, hearing screening activities, and overall satisfaction. RESULTS: Of the 200 questionnaires distributed, 119 parents (59.5%) responded. Overall, more than 80% of parents were satisfied with the program. The highest percentage of satisfaction (95.6%) was related to the contents of an information leaflet. However, parents were not satisfied with items measuring communication aspect of personnel in charge of the hearing screening. In specific, 38.1% of parents were not satisfied with the explanations and information provided by the screeners on the test procedures, while 26.1% of parents found that the information they received on the test results was insufficient. CONCLUSIONS: The findings of the present study revealed that parents were generally satisfied with the UNHS program. However, further intervention is required to improve the communication aspects of the personnel in charge of the hearing testing. Results suggest that the questionnaire is easily employed and effective tool for assessing parental satisfaction with newborn hearing screening programs. Additionally, this study has demonstrated the survey tool to be useful in identifying areas that need changes or improvements.

Effects of ageing and hearing thresholds on speech perception in quiet and in noise perceived in different locations.

BACKGROUND AND OBJECTIVES: This study investigated the effect of ageing on speech perception in quiet and in noise, with noise directed from front, right and left. SUBJECTS AND METHODS: Sixty Malay native adults with normal or near normal hearing comprising of 20 young adults (21 to 39 years old), 20 middle aged (40 to 59 years old) and 20 older adults (60 to 74 years old) participated in this study. Their speech perception ability was measured using the Malay Hearing in Noise Test (HINT) in four test conditions; 1) in quiet (HINT Q), 2) with noise from front (HINT NF), 3) with noise from right (HINT NR), and 4) with noise from left (HINT NL). Reception thresholds for sentences (RTSs) were measured in each of the aforementioned conditions using an adaptive method. RESULTS: The results showed that, 1) genuine age-related decline was found in speech perception performance in HINT (NF), 2) hearing threshold was a major determinant differentiating speech perception performance for HINT (Q) and HINT (NL) conditions, and 3) speech perception performance for HINT (NR) was determined by both age and hearing threshold. CONCLUSIONS: This study suggests that, in older adults, while hearing thresholds affect speech perception in quiet, other factors such as central auditory processing and cognitive functions might be more important determinant factors for speech perception performance in noise.

High frequency tympanometry findings in neonates: does it depend on head position?

OBJECTIVE: The purpose of this study was to investigate the effect of head positions on high frequency tympanometry (HFT) results obtained from neonates. DESIGN: A cross-sectional study to compare HFT results obtained from neonates in two head positions (face sideways and face up). STUDY SAMPLE: One hundred and fifty-seven neonates (80 female, 77 male; mean age = 48.3 ± 26.7 hours) participated. RESULTS: The mean uncompensated admittance at 200 daPa obtained in the face sideways position was significantly greater than that obtained in the face up position (1.02 versus 0.96 mmho). A significant ear effect for baseline compensated admittance was found (right/left = 0.64/0.53 mmho). However, there were no significant main effects for head positions for the tympanometric peak pressure, baseline compensated static admittance, and component compensated static admittance measures, indicating that these measures are resilient to head positions. CONCLUSION: These findings support the use of HFT normative values regardless of the two head positions investigated in the present study.

Test-retest reproducibility of the 1000 Hz tympanometry test in newborn and six-week-old healthy infants.

This study aimed to evaluate the test-retest reproducibility of the high frequency tympanometry (HFT) test measured in healthy infants. A total of 273 newborn babies (106 males and 147 females) were assessed twice (Test 1 and Test 2) on the same day, followed by two more assessments (Test 3 and Test 4) for 118 babies (48 males and 70 females) who returned six weeks later. Five HFT measures including the peak compensated static admittance and component compensated static admittance were assessed for test-retest reproducibility. The results showed no significant differences in mean values of the HFT results between the test and retest conditions for newborn (Test 1/ Test 2) and six-week-old babies (Test 3/ Test 4). High reproducibility for all HFT measures was found for both age groups, as judged by the high intra-correlation coefficients of between 0.75 and 0.95. Normal variations of the HFT measures were established using the 90% range of absolute test-retest difference. Changes in test-retest findings exceeding the 95th percentile values may be considered significant, indicating possible functional changes.

Test-retest reliability of the acoustic stapedial reflex test in healthy neonates.

OBJECTIVE: The acoustic stapedial reflex (ASR) test has been shown to provide useful information about the function of the auditory system. However, the reliability of this test when applied to healthy neonates has not been systematically studied. This study aimed to evaluate the test-retest reliability of the ASR test in newborn babies shortly after birth. DESIGN: Using a cross-sectional design, 219 healthy neonates, aged between 24 and 192 hr, who passed an automated auditory brain stem response screening test, were recruited and assessed using transient-evoked otoacoustic emissions (TEOAEs), high-frequency (1000 Hz) tympanometry, and ASR tests. One randomly selected ear from each neonate was tested. ASRs were elicited by presenting a 2 kHz pure tone and broadband noise (BBN) separately to the test ear in an ipsilateral stimulation mode using a Madsen Otoflex diagnostic immittance meter. A total of 194 (86/108 males/females; 115/79 left/right) ears, which met a set of inclusion criteria, were included in the test-retest reliability analysis for the 2-kHz tone stimulus. In addition, 123 (62/61 males/females; 77/46 left/right) ears were included in the test-retest reliability analysis for the BBN stimulus. The ASR threshold (ASRT) for each stimulus was measured. The ASR procedure was then repeated to acquire retest data. RESULTS: Ipsilateral ASRs were elicited in 91.3% (200/219) of neonates, whereas the remaining 8.7% (19/219) exhibited flat tympanograms (no identifiable peak) and absent reflexes with a "refer" outcome in the TEOAE test. The mean ASRT (76.2 dB HL averaged over 194 ears) for the 2 kHz pure tone was higher than that for the BBN (64.9 dB HL averaged over 123 ears). The findings, based on the results of an analysis of variance with repeated measure, showed that the ASRTs for the retest condition did not differ significantly from those of the first test for both stimuli (p > 0.05). The ASR test also showed high test-retest reliability as demonstrated by intracorrelation coefficients across the test-retest conditions of 0.83 for the 2 kHz pure tone and 0.76 for the BBN stimulus. CONCLUSION: This study demonstrated that ASRs could be consistently elicited from healthy neonates who showed a single-peaked configuration in the high-frequency tympanometry test and passed the automated auditory brain stem response and TEOAE tests. The findings showed that the ASRTs did not vary significantly across the test-retest conditions, and the high intracorrelation coefficients illustrate the reliability of the ASR test. Given the high test-retest reliability, the ASR test holds promise as a useful diagnostic/screening instrument in ascertaining the hearing status in neonates.

High frequency immittance findings: newborn versus six-week-old infants.

This study aimed to compare the high frequency (1 kHz) tympanometry (HFT) and acoustic reflex (AR) measures obtained from infants at birth and at 6-7 weeks of age. HFT results and AR thresholds using a 2-kHz tone and broadband noise activators were obtained from 42 healthy full-term neonates (15 boys and 27 girls) at both test sessions, separated by six weeks. The results showed that the mean values of HFT test parameters and AR thresholds obtained at 6-7 weeks were generally greater than those obtained at birth. In particular, the differences in mean values of uncompensated admittance at 200 daPa, uncompensated peak admittance, uncompensated peak susceptance, peak-compensated static admittance, and AR thresholds with a 2 kHz tone and broadband noise were found to be statistically significant. The findings from this study suggest the need to have separate sets of normative HFT and AR data for infants at birth and 6-7 weeks.