Towards Early Intervention of Hearing Instruments Using Cortical Auditory Evoked Potentials (CAEPs): A Systematic Review
International Journal of Pediatric Otorhinolaryngology
Soleimani, M., Rouhbakhsh, N., et al. (2021).
International Journal of Pediatric Otorhinolaryngology, 144, 110698.
This systematic review investigates the ability of cortical auditory evoked potentials (CAEPs) to estimate aided and unaided thresholds and the applicability of CAEPs in performing device verification and validation for infants and children with hearing loss. This review also explores the utility of CAEPs in increasing caregiver understanding of hearing loss and in improving caregiver ability to make decisions regarding early intervention services.
No funding received
January 2005 to January 2020
Clinical trials, case-control studies, cross-sectional studies, case reports, and case series
28
Cortical auditory evoked potentials (CAEPs) testing demonstrates the ability to estimate aided and unaided behavioral thresholds in infants and children, particularly in children who may not be able to provide reliable behavioral thresholds (e.g., children with multiple disabilities). This review found that CAEP demonstrates higher accuracy for estimating high-frequency versus low-frequency thresholds. One study found that the N1 wave exhibits conformity with behavioral thresholds, and tracking of this wave at various intensities can be used for the measurement of frequency-specific thresholds. Studies investigating the correlation between CAEPs and sensation levels (SLs) reported detection rates varying from 66.4% to 77% for SLs > 10dB. "CAEPs testing is a valid method for confirming the detection of behavioral hearing thresholds, especially in infants with hearing aids" (p. 10).
In studies investigating the verification and validation of hearing aids using cortical auditory evoked potentials (CAEPs), one study found that aided CAEPs assessment results correlate with scores of the Parent's Evaluation of Aural/Oral Performance in Children psychometric questionnaire for hearing aid validation. Another study found an acceptable consistency between CAEPs conventional response detection method and Hotleing's T<sup>2</sup> statistical analysis. Another study found that comparing the presence or absence of CAEPs in aided and unaided conditions is effective for assessing the level of amplification provided by the hearing aid. The authors conclude that "CAEPs are useful tools for verification, validation, and monitoring of the development of the central auditory pathways due to the use of amplifications" (p. 11).
One study investigating caregivers' perspectives on the use of cortical auditory evoked potentials (CAEPs) testing found that all of the families of children with hearing loss (HL) expressed positive views of using CAEPs test with the majority of families describing improved understanding of their child's HL and of the effect of their child's hearing aid. Parental resistance to using hearing aids for their infant with mild to moderate hearing loss decreased from 40% to 19%. Caregivers of children with asymmetrical HL shared that CAEPs testing did not improve their understanding of asymmetrical HL, while other types of audiological assessments did improve their understanding. More research from diverse caregiver/family perspectives (e.g., different countries, different languages, and different timepoints during the intervention process) is warranted.
To assess frequency-lowering technology in hearing aids, several studies compared the results of cortical auditory evoked potentials (CAEPs) using high-frequency sounds in both the activated and deactivated conditions. The authors of this review conclude that "CAEPs testing can be used as an objective method for assessing the effectiveness of the frequency-lowering technology" (p. 12) for children with hearing loss. Additional research on the use of CAEPs testing for other hearing aid technologies (e.g., speech enhancement, noise reduction) in young children or children unable to participate in behavioral testing is warranted.
"P1 latency can be used as an objective tool to determine whether acoustic amplification can provide adequate excitation for the development of the central auditory pathways in hearing-impaired children and make early decisions on referral for cochlear implants" (p. 11). Using CAEPs, hearing aid fitting age decreased from 9.2 months to 3.9 months, and the age at referral for cochlear implantation reduced from 20.2 months to 8.2 months.
