Steady-State Auditory Evoked Potentials (SSAEPs) in Patients with Hypoacusia Who Can Not Collaborate

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; LOPEZ, A.; ALCARAZ, A.; BARDACH, A.; CIAPONI, A

Documento de Evaluación de Tecnologias Sanitarias

IECS

Año: 2013 p. 1 - 30

1668-2793

Congenital hypoacusia is the most common sensorial anomaly and in 50% of the patients it is not accompanied by any other anomaly. Most patients are born from normal hearing parents. This disorder is associated with delays in language acquisition and learning and it also presents other adverse consequences in the child and his/her family.During the last decade, neonatal auditory screening has been adopted in most developed countries by using otoacoustic emission measurements and auditory brainstem response (ABR). There is evidence suggesting that early diagnosis and an adequate intervention might improve disease evolution.Auditory steady-state response (ASSR) are currently presented as a diagnostic alternative that might have a better diagnostic profile than ABR, thus allowing simultaneous evaluation of several frequencies in both ears.TechnologyAuditory evoked potentials are the recording of the brain response to repetitive acoustic stimuli. Unlike ABR, ASSR use multiple-frequency repetitive acoustic stimuli which are tonal stimuli broadly modulated, i.e. sounds than increase and decrease in intensity. The use of specific stimuli, simultaneously introduced, would allow a faster and more specific evaluation of several frequencies at the same time thus allowing assessment of different thresholds. To conduct this test, direct collaboration of the patient is not required. The response is automatically and statistically analyzed and is graphically presented, this way, subjectivity is reduced.PurposeTo evaluate the available evidence on efficacy, safety and coverage policy related issues on the use of steady-state auditory evoked potentials (ASSR) in patients with hypoacusia who cannot collaborate.MethodsA bibliographic search was carried out on the main databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews; controlled, randomized clinical trials (RCTs); health technology assessments and economic evaluations; clinical practice guidelines and coverage policies of other health systems.ResultsNo studies assessing if ASSR has any advantage over ABR in the context of neonatal screening have been found, neither in patients who cannot collaborate.Cross-sectional studies found show that, in general, there is adequate correlation between both studies.The different HTAs or guidelines found, as well as the health sponsors evaluated, do not consider it as a strategy for screening neonatal deafness. Some consider that ASSR might be included in the workup to be conducted, in general, after acoustic otoemissions and ABR, but still there is no consensus if ABR could replace ABR.ConclusionsThe studies published on the diagnostic profile of ASSR compared with ABR are few and of poor methodological quality.In this sense, clinical guidelines as well as other HTA documents and the health sponsors evaluated mention this technology and consider ASSR cannot replace ABR, but might become part of the diagnostic workup in patients with hypoacusia in some selected cases.