Auditory Brainstem Response with chirp stimuli in newborns: an integrative review

Rezende, Ana Luiza de Freitas; Resende, Luciana Macedo de; Valadares, Ana Carolina Andrade; Carvalho, Sirley Alves da Silva

doi:10.1590/1982-0216/20222442522

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REVIEW ARTICLES • Rev. CEFAC 24 (4) • 2022 • https://doi.org/10.1590/1982-0216/20222442522 copy

Auditory Brainstem Response with chirp stimuli in newborns: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to review the literature available on electrophysiological findings on ABR with chirp stimuli in newborns.

Methods:

articles were searched in PubMed, MEDLINE, Scopus, Web of Science, LILACS, and SciELO. Papers published in English and Portuguese between 2010 and 2020 were selected, including those that addressed ABR with air-conduction broadband chirp stimuli in newborns, that assessed ABR with a specific frequency, and that compared ABR results with chirp and click stimuli. Articles that assessed only bone-conduction results, duplicates, literature reviews, case reports, letters, and editorials were excluded.

Literature review:

the search strategy resulted in nine selected articles. Four studies (44.4%) analyzed ABR wave amplitude and latency with chirp stimuli, three studies (33.3%) compared the time of ABR procedures between chirp and click stimuli, two studies (22.2%) analyzed only amplitude, and two (22.2%), verified the specificity of ABR with chirp stimuli in neonatal hearing screening.

Conclusion:

chirp stimuli elicit responses with greater amplitudes, lower latencies, and shorter examination time than those with click stimuli in newborns.

Keywords:
Infant, Newborn; Auditory Evoked Potentials; Brain Stem

Authors (Year)	Design	Sample	Main findings
Cebulla et al.¹³ (2012)	Cross-sectional study	6,866 newborns without RIHL up to 48 hours after birth, in the first stage, and 6 to 8 weeks old in the second stage	6,607 (96.2%) screened newborns “passed” the hearing screening before hospital discharge, using MB11 BERAphone1. Of the 259 newborns referred for a retest, 188 did not “pass”, and 47 had hearing loss confirmed with diagnosis. The specificity of the device used in the study was 97.9%.
Muhler et al.¹² (2013)	Cross-sectional study	46 children up to 48 months old	The mean V-wave amplitudes elicited with chirp stimuli were much greater than with click stimuli, almost reaching adult values among older participants. Using chirp stimuli is indicated to research electrophysiological thresholds because they are more reliable and can be measured on higher levels of residual EEG noise than the click stimuli.
Cebulla et al.¹⁴ (2014)	Cross-sectional study	96 normal-hearing newborns less than 5 days old	Chirp ABR differ from click ABR in that they have significantly greater ABR responses. The chirp stimuli are expected to produce more reliable results and especially shorter measuring times, leading to greater quality of hearing screening and hearing threshold assessments.
Stuart et al.¹¹ (2014)	Cross-sectional study	23 healthy newborns with gestational ages between 36 and 40 weeks	Using chirp stimuli in neonatal hearing screening can significantly improve ABR response amplitude and decrease the examination time. The loss in examination sensitivity may be a disadvantage of using chirp stimuli in ABR neonatal screening. Further studies with chirp stimuli to assess newborns are needed.
Almeida et al.¹⁷ (2014)	Cross-sectional study	40 newborns with and without RIHL	AABR with CE-chirp stimuli has greater specificity and fewer false-positive cases than with click stimuli at 30 dBnHL and 35 dBnHL and shorter response detection time.
Cobb et al.⁹ (2016)	Cross-sectional study	168 newborns without RIHL	In general, ABR V-wave amplitudes with air-conduction CE-chirp stimuli were significantly greater (p < 0.05) than with click stimuli. There were statistically significant systematic differences (p < 0.05).
Cobb et al.¹⁰ (2016)	Cross-sectional study	168 healthy newborns and 20 normal-hearing adults	There are significant differences in ABR latencies and amplitudes between newborns and young adults using CE-chirp stimuli. These differences are consistent with click-stimuli differences and reflect age-related maturational differences. These findings further emphasize the importance of interpreting ABR results with normative data according to age.
Lopes et al.¹⁵ (2020)	Cross-sectional study	46 newborns without RIHL	The mean time of the AABR procedure with CE-chirp stimuli is three times shorter than with click stimuli.
Ferreira et al.¹⁶ (2020)	Cross-sectional study	30 full-term newborns without RIHL	ABR V wave in newborns is not influenced by their sex when broadband Ichirp stimuli are used.

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[1] Corresponding address: Ana Carolina Andrade Valadares, Avenida Professor Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 - Belo Horizonte, Minas Gerais, Brasil, E-mail: anacarolinaandrade38@gmail.com