Sensitivity of cortical auditory evoked potential detection for hearing-impaired infants in response to short speech sounds

Background: Cortical auditory evoked potentials (CAEPs) are an emerging tool for hearing aid fitting evaluation in young children who cannot provide reliable behavioral feedback. It is therefore useful to determine the relationship between the sensation level of speech sounds and the detection sensitivity of CAEPs. Design and methods: Twenty-five sensorineurally hearing impaired infants with an age range of 8 to 30 months were tested once, 18 aided and 7 unaided. First, behavioral thresholds of speech stimuli /m/, /g/, and /t/ were determined using visual reinforcement orientation audiometry (VROA). Afterwards, the same speech stimuli were presented at 55, 65, and 75 dB SPL, and CAEP recordings were made. An automatic statistical detection paradigm was used for CAEP detection. Results: For sensation levels above 0, 10, and 20 dB respectively, detection sensitivities were equal to 72 ± 10, 75 ± 10, and 78 ± 12%. In 79% of the cases, automatic detection p-values became smaller when the sensation level was increased by 10 dB. Conclusions: The results of this study suggest that the presence or absence of CAEPs can provide some indication of the audibility of a speech sound for infants with sensorineural hearing loss. The detection of a CAEP provides confidence, to a degree commensurate with the detection probability, that the infant is detecting that sound at the level presented. When testing infants where the audibility of speech sounds has not been established behaviorally, the lack of a cortical response indicates the possibility, but by no means a certainty, that the sensation level is 10 dB or less.