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Introduction <p>Hearing loss affects over 466&#xa0;million individuals worldwide, significantly impairing communication, social integration, and quality of life. Pure Tone Audiometry (PTA) remains the gold standard for assessing hearing thresholds; however, its reliance on patient cooperation limits its applicability in individuals unable to provide consistent behavioural responses. Brainstem Evoked Response Audiometry (BERA) and Auditory Steady-State Response (ASSR) offer objective alternatives. This study evaluates the diagnostic accuracy and clinical utility of PTA, BERA, and ASSR in adults with hearing loss, emphasizing their complementary roles.</p> Methodology <p>This cross-sectional study included 200 adults aged 18–80 years with suspected hearing loss. Participants underwent PTA, BERA, and ASSR testing in sound-controlled environments. Mean thresholds, sensitivity, specificity, correlation coefficients, and Receiver Operating Characteristic (ROC) curves were analysed. Subgroup analyses were performed based on age and type of hearing loss. Statistical analyses were conducted using SPSS ver. 26.</p> Results <p>ASSR demonstrated the highest sensitivity (97%) and specificity (94%) for severe-to-profound hearing loss, surpassing BERA (92% sensitivity, 89% specificity). Strong correlations were observed between ASSR and PTA thresholds (<i>r</i> = 0.93), with Bland-Altman analysis showing minimal bias (mean difference: 2.5 dB). Subgroup analyses confirmed ASSR’s superior diagnostic accuracy in older adults (≥ 50 years) and sensorineural hearing loss. Regression models further validated ASSR’s reliability (R<sup>2</sup> = 0.85–0.88).</p> Conclusion <p>PTA, BERA, and ASSR demonstrate complementary diagnostic value in adult hearing loss. ASSR showed superior precision in estimating thresholds, particularly in cases of severe-to-profound and sensorineural hearing loss. Incorporating ASSR into diagnostic protocols may enhance clinical decision-making and outcomes.</p>

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Comparative Diagnostic Utility of Pure Tone Audiometry, Brainstem Evoked Response Audiometry, and Auditory Steady-State Response in Adult Hearing Loss: An Institutional Experience

  • 期刊论文

  • 发表日期：

    2025年6月6日

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  • Srujan Vallur,
  • Sanjay Kumar,
  • Angshuman Dutta,
  • Ran Singh,
  • Rashmi Natraj

摘要

Introduction

Hearing loss affects over 466 million individuals worldwide, significantly impairing communication, social integration, and quality of life. Pure Tone Audiometry (PTA) remains the gold standard for assessing hearing thresholds; however, its reliance on patient cooperation limits its applicability in individuals unable to provide consistent behavioural responses. Brainstem Evoked Response Audiometry (BERA) and Auditory Steady-State Response (ASSR) offer objective alternatives. This study evaluates the diagnostic accuracy and clinical utility of PTA, BERA, and ASSR in adults with hearing loss, emphasizing their complementary roles.

Methodology

This cross-sectional study included 200 adults aged 18–80 years with suspected hearing loss. Participants underwent PTA, BERA, and ASSR testing in sound-controlled environments. Mean thresholds, sensitivity, specificity, correlation coefficients, and Receiver Operating Characteristic (ROC) curves were analysed. Subgroup analyses were performed based on age and type of hearing loss. Statistical analyses were conducted using SPSS ver. 26.

Results

ASSR demonstrated the highest sensitivity (97%) and specificity (94%) for severe-to-profound hearing loss, surpassing BERA (92% sensitivity, 89% specificity). Strong correlations were observed between ASSR and PTA thresholds (r = 0.93), with Bland-Altman analysis showing minimal bias (mean difference: 2.5 dB). Subgroup analyses confirmed ASSR’s superior diagnostic accuracy in older adults (≥ 50 years) and sensorineural hearing loss. Regression models further validated ASSR’s reliability (R2 = 0.85–0.88).

Conclusion

PTA, BERA, and ASSR demonstrate complementary diagnostic value in adult hearing loss. ASSR showed superior precision in estimating thresholds, particularly in cases of severe-to-profound and sensorineural hearing loss. Incorporating ASSR into diagnostic protocols may enhance clinical decision-making and outcomes.