International Journal of Pediatric Otorhinolaryngology (2007) 71, 775779

www.elsevier.com/locate/ijporl

500 Hz logon versus click ABR maturation

S. Ku
lekci *, S. Terlemez, A. C
iprut, F. Akdas

Department of Audiology, Marmara University Medical School, Istanbul, Turkey

Received 17 October 2006; received in revised form 22 January 2007; accepted 23 January 2007

KEYWORDS
Auditory brainstem
response;
Click;
Tone burst stimuli
(logon)

Summary
Objectives: To provide age-equivalent norms for a 500 Hz logon evoked ABR obtained
in a group of children ranging 40 weeks4 years old and compare these 500 Hz tonal
norms to age-equivalent norms for click-evoked ABR.
Methods: Seventy-seven infants and children ranging from conceptional age of 40
weeks (term babies) to 4 years were tested with both click and tonal ABR without any
risk factors for hearing loss.
Results: Data analyses were consisted of 6 age groups. Mean wave V latencies were
compared with the adult norms. Latencies were decreased by age in both click and
tonal ABR recordings.
Conclusion: Five hundred Hertz of tonal ABR wave V latency did not mature until to
24 years old but, click ABR wave V latency reached maturity at the same age range.
# 2007 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
The primary goal of evoked potential audiometry is
to provide the accurate audiometric information for
infants and difficult-to-test children. The auditory
brain stem response (ABR) to air-conducted clicks is
the most widely employed evoked potential audiometry technique. While informative and accurate in
most cases, the use of clicks has many drawbacks.
Clicks cannot provide reliable estimates of low fre-

Abbreviation: ABR, auditory brainstem response

* Corresponding author at: Tekin sok. Besen Sitesi B Blok D:7,
Acbadem, 34718 Istanbul, Turkey. Tel.: +90 2163250919; fax: +90
2163399747.
E-mail address: sezer53@yahoo.com (S. Ku
lekci).

quency hearing. The solution to this problem is to

use more frequency specific procedures [1,2].
Often ABR testing employs click to assess high
frequency hearing (20004000 Hz), and low frequency tone bursts (500 Hz) to assess low frequency
hearing [3,4]. A click produced ABR does not just
represent hearing in 20004000 Hz zone of the
cochlea but is an excellent (r = 0.98) predictor of
average hearing loss [5]. Numerous reports have
shown a maturation effect of the ABR from birth to
approximately 2 years of age when click stimuli [6
11]. However similar data are lacking for low frequency stimuli, that is, 500 Hz. Further, there are
conflicting data concerning frequency specific development with one data set [11,12] suggesting that
low-frequency sensitivity development occurs more
slowly than mid-frequency sensitivity development.

0165-5876/$ see front matter # 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijporl.2007.01.016

776

S. Ku
lekci et al.

While other data set [13] suggests that frequency

development occurs more rapidly for lower than for
higher frequency stimulation.
Auditory maturation progresses at a nonlinear
rate with the largest ABR latency changes occurring
earlier in the developmental sequence [7,1418].
The age span for the infant groups was generally
larger as age increased [11].
Normative data can be referred to as latency
intensity information; such as we are accustomed
to seeing for click ABRs. This type of data is not
readily available for logon and tone bursts currently,
and hence each clinic would benefit from developing
their own norms.
Age-equivalent ABR norms are important when
predicting hearing levels in neonates and infants.
Moreover, because the ABR is a test of neurosynchrony, delayed absolute latencies can often indicate other pathologies or unique conditions [10].
Therefore, it is useful to have age-equivalent norms
for low-frequency tonal stimuli.
In the present paper we provide age-equivalent
norms for a 500 Hz logon evoked ABR obtained in a
group of children ranging in age from 40 weeks to 4
years and compare these 500 Hz tonal norms to ageequivalent norms for click-evoked ABR [19,20].

2. Methods
2.1. Subjects
Seventy-seven infants and children ranging from
conceptional age of 40 weeks (term babies) to 4
years were tested with ABR without any risk factors
for hearing loss. Thirty of them were female, 47 of
them were male.

Fig. 1

Both for the click and tonal ABR stimuli, they had
responses at 70, 55 and 30 dB nHL. Only the latency
data from the right ear were used for analyses.
Testing 20 young adults with normal hearing
(thresholds for 2508000 Hz were 15 dB HL) indicated that the average and modal psychophysical
threshold for the 500 Hz ABR stimuli was
35 dB peSPL and for the click stimuli it was 30 dB
peSPL.

2.2. Procedures
The infants were sedated with chloral hydrate
(40 mg/kg) and were medically cleared of middle
ear disease. Testing was performed in a sound proof
test room (IAC) using Amplaid MK 15 evoked potentials systems. The stimuli were 70, 55 and 30 dB nHL
and (re:30 dB peak equivalent SPL) alternating
100 ms duration clicks at a rate of 31 s 1 with the
filter bandpass at 1002500 Hz and the time base at
15 ms. For the 500 Hz logon testing, the bandpass
was 301500 Hz with a 20 ms timebase. The stimuli
were 70, 55 and 30 dB nHL and the repetition rate
was 31 s 1. This stimuli is a short pure tone stimulus
in which the bandwidth is kept constant, and it has a
fixed number of cycles on the rise-plateau-fall time.
The frequency/amplitude spectrum of a 500 Hz
logon as well as the acoustic waveform, are illustrated in Fig. 1. Due to its physical features, delta
time and delta frequency, it guarantees a constant
band of frequencies in octaves for the different
frequencies of the test [21]. All ABRs were two
channel recordings from Cz-M1 versus Cz-M2, Fpz.
Each ABR was replicated twice and at least 2000
sweeps collected.
Statistical analysis was evaluated with paired ttest (SPSS ver.14), p < 0.05.

The frequency/amplitude spectrum and acoustic waveform of a 500 Hz logon.

500 Hz logon versus click ABR maturation

777

Table 1 Infant groups by age

Age

Number in group (n)

3940 weeks
4446 weeks
24 months
68 months
1016 months
24 years

14
10
12
12
10
19

Fig. 3 Mean wave V latency/intensity functions by age

group for click stimuli.

Fig. 2 Mean (S.D.) latency of wave V for a click and wave

V 500 Hz tone burst at 70 dB nHL.

This study was approved by Marmara University

Ethical committee and inform consent was obtained
from family members.

Fig. 4 Mean wave V 500 Hz latency/intensity functions

by age group.

3. Results
Seventy-seven infants and children were divided
into six groups as outlined in Table 1.
Absolute latencies were measured for wave V at
70, 55 and 30 dB nHL in response to click, and 500 Hz
logon stimuli. The mean wave V latency data were
analyzed by age groups for significant changes using
a paired sample t-test p < 0.05. Table 2 lists the
means  2.5 S.D.s of wave V data by ages for click
and 500 Hz logon stimuli.
The latency values of waves V at 70 dB nHL both
for click and tonal stimuli are displayed in Fig. 2.
Fig. 3 shows the latency values for the click
stimuli at 70, 55 and 30 dB nHL.
Fig. 4 displays the latency values for the 500 Hz
logon stimuli at 70, 55 and 30 dB nHL. There is a

Fig. 5 Mean wave V latency values as a function of age at

70 dB nHL for click.

significant decrease in wave V latency until 24

years for click stimuli and the latency reaches the
adults norms at this age range ( p < 0.05). But in the
same age group for the 500 Hz tonal stimuli wave V
latency did not reach maturation until after 24
years of age ( p > 0.05) (Figs. 3 and 4).

Table 2 Mean S.D. latency values by CA for click and 500 Hz logon stimuli
Age (n)

Click 70 dB

Click 55 dB

Click 30 dB

.5k 70 dB

.5k 55 dB

.5k 30 dB

3940 weeks (14)

4446 weeks (10)
24 months (12)
68 months (12)
1016 months (10)
24 years (19)
Adult

6.79
6.61
6.35
6.19
5.95
5.73
5.50

7.13
6.94
6.71
6.46
6.14
5.98
5.82

8.15
8.03
7.63
7.28
7.11
7.01

9.66
9.14
9.00
8.79
8.72
8.61
7.56

11.58
11.13
11.13
10.52
10.25
10.45
8.79

13.32
12.82
13.16
12.79
12.68
12.74
10.80

(0.29)
(0.28)
(0.20)
(0.27)
(0.26)
(0.22)
(0.05)

(0.34)
(0.29)
(0.19)
(0.26)
(0.24)
(0.25)
(0.25)

(0.39)
(0.27)
(0.28)
(0.30)
(0.36)
(0.37)

(0.46)
(0.85)
(0.59)
(0.24)
(0.37)
(0.98)
(0.37)

(0.87)
(0.92)
(1.30)
(0.77)
(0.58)
(1.25)
(0.58)

(1.39)
(1.13)
(1.23)
(0.91)
(1.20)
(1.28)
(0.79)

778

Fig. 6 Mean wave V latency values as a function of age at

55 dB nHL for click.

Fig. 7 Mean wave V latency values as a function of age at

30 dB nHL for click.

Slope of the age versus wave V latency function

for each intensity investigated (Figs. 510).

4. Discussion
Our study had three purposes: (1) to provide ageequivalent norms for a 500 Hz logon evoked ABR
obtained from a group of infants; (2) to compare
these logon ABR norms to age-equivalent norms for
click-evoked ABR; and (3) to investigate the issue of
maturational development according to 500 Hz
logon stimuli.
Wave V latency in response to 500 Hz logon
decreased with age and did not stabilize by 24 years
of age. Wave V latency in response to clicks decreased

Fig. 8 Mean wave V latency values as a function of age at

70 dB nHL for 500 Hz logon.

S. Ku
lekci et al.

Fig. 9 Mean wave V latency values as a function of age at

55 dB nHL for 500 Hz logon.

Fig. 10 Mean wave V latency values as a function of age

at 30 dB nHL for 500 Hz logon.

with age, as has been reported by others [11,19].

These results are consistent with other investigations, which suggest a progressive decrease in wave
V latency until 1824 months of age postdelivery [9
11,22]. Specifically, the data of Gorga et al. [10] and
Ponton et al. [11] shows that wave V latency stabilizes
by 2324 months postbirth, while the data of Hexos
and Galambos [22] shows that the wave V latency
stabilizes by 18 months postbirth. Ponton and colleagues [11] show that low-frequency tone burst development is complete by 23 months postbirth. They
suggested that the wave V latency for click and lowfrequency logon develops at the same rate [11].
Hurley et al. [19] shows that major wave latency
in response to 500 Hz tone bursts decreases with age
and do not stabilize by 70 weeks CA and also wave V
latency in response to clicks decreases with age and
do not stabilize by 70 weeks CA.
In our study, 500 Hz logon latency for the wave V
did not stabilize in the 24 years old range, although
we observed that click ABR latencies in the same age
group reached the adult values.
Our tonal ABR findings are different from other
studies which states that the wave V latency reaches
the adult norms at around the 2 years of age.
In conclusion:
 The results of the present study suggest dissimilarity between wave V ABR latencies to clicks and

500 Hz logon versus click ABR maturation

500 Hz logon stimuli. Five hundred Hertz of ABR
latencies are longer than click latencies.
 Although our click-evoked ABR data is consistent
with the previously reported data, 500 Hz logon
data is not consistent with other studies. While
the wave V latency for low-frequency logon development did not complete, wave V latency produced with the click stimuli stabilized by 24
years. As well, there was a statistically significant
difference between ABR maturations to click and
logon stimuli.
Our click stimulus wave V latency data were consistent with previously published data [10,19,23].
These graphic comparisons are displayed in Fig. 1.
In reviewing this figure, note that for all age groups
our wave V latency data falls well within the mean
(2.5 S.D.s) of the previous data [9,10].
Frequency specific development data set suggesting that low-frequency sensitivity development
occurs more slowly than mid-frequency sensitivity
development [11].

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