Clinical Case · Clinician

A profoundly deaf child being assessed for cochlear implantation

Vignette

A 14-month-old with profound bilateral hearing loss is being worked up for cochlear implantation. Click ABR showed no response at maximum output. A multiple-frequency ASSR is recorded, with stimuli presented at high intensities and a down-seeking search.

Audiogram

-10020406080100120500 Hz1k Hz2k Hz4k HzHearing level (dB HL)
O Right earX Left ear
Estimated thresholds by ear. O = right, X = left.

ASSR finding

ASSR detects low-frequency responses at very high intensities (around 95–100 dB HL at 500 Hz) where the ABR had reached its output ceiling; no response at the higher carriers within the tested range.

Diagnostic question

What is the principal advantage of ASSR over ABR in this assessment?