# The relationship between auditory steady-state response and behavioural audiometry in hearing estimation for infants: a meta-analysis

## TL;DR

This study compares how well auditory steady-state response (ASSR) predicts hearing thresholds in infants compared to behavioral audiometry, finding that it is reasonably accurate but with some variability.

## Contribution

A meta-analysis quantifying the threshold differences between ASSR and behavioral audiometry in infants for hearing estimation.

## Key findings

- ASSR thresholds were on average 6.35 to 9.24 dB higher than behavioral audiometry thresholds across four frequencies.
- Substantial heterogeneity was observed among the included studies, indicating variability in results.
- The study confirms that ASSR provides a reasonably accurate prediction of hearing thresholds in infants.

## Abstract

Auditory Steady-State Response (ASSR) allows the identification of infants with hearing loss and consequently early intervention. Therefore, it is important to assess the accuracy of ASSR for determining hearing thresholds in infants. This study aimed to systematically review the threshold differences between air-conducted ASSR and behavioural audiometry (BA) in infants.

The population was infants younger than 2 years; the intervention was ASSR thresholds; the comparator was BA thresholds; and the outcome was the ASSR-BA threshold, i.e., the correction value in dB. PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, and Embase were searched. The risk of bias was evaluated using the Evidence Project risk of bias tool and the Newcastle–Ottawa Quality Assessment Scale. The mean and 95% confidence intervals (CI) were calculated for the threshold differences at four frequencies (0.5, 1, 2, and 4 kHz).

Of 503 articles identified, 10 were eligible for a narrative summary, and seven were included in the meta-analysis, which had a total of 2845 ASSR-BA thresholds. The articles were of moderate quality and showed substantial heterogeneity (I2 between 89 and 96%, p < 0.01). The mean differences (± 95% CI) between ASSR thresholds and BA hearing thresholds were 9.24 dB (± 6.45), 7.19 dB (± 4.02), 6.35 dB (± 4.51), and 7.42 dB (± 5.40) at 0.5, 1, 2, and 4 kHz, respectively.

ASSR provides a reasonably accurate prediction of BA thresholds. Given the heterogeneity of the included studies, further research with larger infant populations is needed.

The study was pre-registered in PROSPERO and followed PRISMA-P 2015 statement.

The online version contains supplementary material available at 10.1186/s13643-025-03003-x.