Correlation Between Auditory Steady-State Responses and Pure-Tone Audiometry in Hearing Threshold Assessment

Introduction: Accurate assessment of hearing thresholds is a fundamental component of the diagnosis and management of hearing disorders. Although pure-tone audiometry remains the gold standard, its application may be limited in non-cooperative patients or in certain complex clinical situations. Auditory Steady-State Responses (ASSR) provide an objective, frequency-specific method for estimating hearing thresholds. Aim: This study aimed to evaluate the correlation between ASSR-derived thresholds and behavioural pure-tone audiometry thresholds, and to assess the clinical contribution of ASSR in audiological evaluation. Materials and Methods: This observational study, conducted in the Department of Otorhinolaryngology and Cervico-Facial Surgery at the 20 August Hospital, Ibn Rochd University Hospital Centre in Casablanca, over ten months from September 2023 to July 2024, included fifty-three patients evaluated for suspected hearing impairment who underwent both pure-tone audiometry and ASSR testing. Hearing thresholds were analysed at standard frequencies (500, 1000, 2000, and 4000 Hz). ASSR thresholds were compared with behavioural audiometric thresholds to assess correlation, mean differences, and agreement in audiometric configuration. Statistical analysis was performed to determine the strength and significance of correlations and to evaluate the influence of clinical parameters on test performance. Results: A statistically significant correlation was found between ASSR-derived thresholds and pure-tone audiometry thresholds, particularly at speech frequencies. Mean differences between the two methods were generally small and clinically acceptable. ASSR accurately reproduced the audiometric configuration in most cases, with greater precision observed in severe to profound hearing loss. Slightly reduced reliability was noted at lower frequencies; however, this did not compromise the overall diagnostic value of the method. Conclusion: These findings confirm the reliability of ASSR as an objective tool for estimating hearing thresholds and its strong agreement with pure-tone audiometry. ASSR is particularly valuable in non-cooperative patients, in cases of severe to profound hearing loss, and in situations requiring objective confirmation of auditory thresholds. While ASSR does not replace behavioural audiometry, it represents an essential complementary tool within an integrated audiological assessment, contributing to improved diagnostic accuracy and therapeutic decision-making in otorhinolaryngology.