Acoustic Stapedial Reflexes in Healthy Neonates: Normative Data and Test-Retest Reliability

Abstract

Background: The acoustic stapedial reflex (ASR) test provides useful information about the function of the auditory system. While it is frequently used with adults and children in a clinical setting, its use with young infants is limited. Presently, there are few data for neonates and inadequate research into the test-retest reliability of the ASR test. Purpose: This study aimed to establish normative data and evaluate the test-retest reliability of the ASR test in healthy neonates. Research Design: A cross-sectional experimental design was used to establish ASR normative data and assess the test-retest reliability of ASR thresholds obtained from healthy neonates. Study Sample: Sixty-eight full-term neonates with mean chronological age of 2.5 days (SD = 1.8 day), who passed the automated auditory brainstem response, transient evoked otoacoustic emission, and high frequency (1 kHz) tympanometry (HFT) tests. Data Collection and Analysis: One randomly selected ear from each neonate was tested using TEOAE (transient evoked otoacoustic emission), HFT, and ASR tests using a 1 kHz probe tone. ASR thresholds were elicited by presenting pure tones of 0.5, 2, and 4 kHz and broadband noise (BBN) separately to the test ear in an ipsilateral stimulation mode. The ASR procedure was repeated to acquire retest data within the same testing session. Descriptive statistics, χ2, and analysis of variance with repeated measures tests were used to analyze ASR data. Results: All neonates exhibited ASR when stimulated by tonal stimuli or BBN. The mean ASRTs (acoustic stapedial reflex thresholds) for the 0.5, 2, and 4 kHz tones were 81.6 ± 7.9, 71.3 ± 7.9, and 65.4 ± 8.7 dB HL, respectively. The mean ASRT for the BBN was estimated to be smaller than 57.2 dB HL, given the limitation of the equipment. The 95th percentiles of the ASRT were 95, 85, 80, and 75 dB HL for the 0.5, 2, and 4 kHz and BBN, respectively. The test-retest reliability of the ASR test for all stimuli was high, with no significant difference in mean ASRTs across the test and retest conditions. Test-retest differences were within 10 dB for more than 91% of ASRT data across all stimuli. There was a slight trend of ASRTs being more repeatable in the medium ASRT range than in the higher or lower range. Conclusions: This study demonstrated that ASRTs obtained from healthy neonates were highly repeatable across test and retest sessions. Given the availability of normative data and the high test-retest reliability, the ASR test will be useful as a diagnostic tool in a battery of tests to evaluate the auditory function of neonates.