Abstract：
OBJECTIVE: The acoustic change complex (ACC) is a cortical auditory evoked potential (CAEP) and can be elicited by a change in an otherwise continuous sound. The ACC has been highlighted as a promising tool in the assessment of sound and speech discrimination capacity, and particularly for difficult-to-test populations such as infants with hearing loss, due to the objective nature of ACC measurements. Indeed, there is a pressing need to develop further means to accurately and thoroughly establish the hearing status of children with hearing loss, to help guide hearing interventions in a timely manner. Despite the potential of the ACC method, ACC measurements remain relatively rare in a standard clinical settings. The objective of this study was to perform an up-to-date systematic review on ACC measurements in children, to provide greater clarity and consensus on the possible methodologies, applications, and performance of this technique, and to facilitate its uptake in relevant clinical settings.
METHODS: Original peer-reviewed articles conducting ACC measurements in children (< 18 years). Data were extracted and summarised for: (1) participant characteristics; (2) ACC methods and auditory stimuli; (3) information related to the performance of the ACC technique; (4) ACC measurement outcomes, advantages, and challenges. The systematic review was conducted using PRISMA guidelines for reporting and the methodological quality of included articles was assessed.
RESULTS: A total of 28 studies were identified (9 infant studies). Review results show that ACC responses can be measured in infants (from < 3 months), and there is evidence of age-dependency, including increased robustness of the ACC response with increasing childhood age. Clinical applications include the measurement of the neural capacity for speech and non-speech sound discrimination in children with hearing loss, auditory neuropathy spectrum disorder (ANSD) and central auditory processing disorder (CAPD). Additionally, ACCs can be recorded in children with hearing aids, auditory brainstem implants, and cochlear implants, and ACC results may guide hearing intervention/rehabilitation strategies. The review identified that the time taken to perform ACC measurements was often lengthy; the development of more efficient ACC test procedures for children would be beneficial. Comparisons between objective ACC measurements and behavioural measures of sound discrimination showed significant correlations for some, but not all, included studies.
CONCLUSIONS: ACC measurements of the neural capacity to discriminate between speech and non-speech sounds are feasible in infants and children, and a wide range of possible clinical applications exist, although more time-efficient procedures would be advantageous for clinical uptake. A consideration of age and maturational effects is recommended, and further research is required to investigate the relationship between objective ACC measures and behavioural measures of sound and speech perception for effective clinical implementation.
METHODS: Original peer-reviewed articles conducting ACC measurements in children (< 18 years). Data were extracted and summarised for: (1) participant characteristics; (2) ACC methods and auditory stimuli; (3) information related to the performance of the ACC technique; (4) ACC measurement outcomes, advantages, and challenges. The systematic review was conducted using PRISMA guidelines for reporting and the methodological quality of included articles was assessed.
RESULTS: A total of 28 studies were identified (9 infant studies). Review results show that ACC responses can be measured in infants (from < 3 months), and there is evidence of age-dependency, including increased robustness of the ACC response with increasing childhood age. Clinical applications include the measurement of the neural capacity for speech and non-speech sound discrimination in children with hearing loss, auditory neuropathy spectrum disorder (ANSD) and central auditory processing disorder (CAPD). Additionally, ACCs can be recorded in children with hearing aids, auditory brainstem implants, and cochlear implants, and ACC results may guide hearing intervention/rehabilitation strategies. The review identified that the time taken to perform ACC measurements was often lengthy; the development of more efficient ACC test procedures for children would be beneficial. Comparisons between objective ACC measurements and behavioural measures of sound discrimination showed significant correlations for some, but not all, included studies.
CONCLUSIONS: ACC measurements of the neural capacity to discriminate between speech and non-speech sounds are feasible in infants and children, and a wide range of possible clinical applications exist, although more time-efficient procedures would be advantageous for clinical uptake. A consideration of age and maturational effects is recommended, and further research is required to investigate the relationship between objective ACC measures and behavioural measures of sound and speech perception for effective clinical implementation.
摘要：
目的：声学变化复合体（ACC）是一种皮层听觉诱发电位（CAEP），可以通过其他连续声音的变化引起。行政协调会被强调为评估声音和言语歧视能力的一个有前途的工具，特别是对于难以测试的人群，如听力损失的婴儿，由于ACC测量的客观性。的确,迫切需要进一步发展手段，准确、彻底地确定听力损失儿童的听力状况，帮助及时指导听力干预。尽管ACC方法具有潜力，ACC测量在标准临床设置中仍然相对罕见。这项研究的目的是对儿童的ACC测量进行最新的系统评价，为了在可能的方法上提供更大的清晰度和共识，应用程序,和这种技术的性能，并促进其在相关临床环境中的吸收。
方法：在儿童（<18岁）中进行ACC测量的原始同行评审文章。数据被提取和总结为：（1）参与者特征;（2）ACC方法和听觉刺激;（3）与ACC技术性能相关的信息;（4）ACC测量结果，优势,和挑战。使用PRISMA报告指南进行系统审查，并评估纳入文章的方法学质量。
结果：共确定了28项研究（9项婴儿研究）。审查结果表明，ACC反应可以测量婴儿（从<3个月），有证据表明年龄依赖性，包括随着儿童年龄的增加，ACC反应的稳健性增加。临床应用包括测量听力损失儿童的言语和非言语声音辨别的神经能力，听觉神经病变谱系障碍（ANSD）和中枢听觉处理障碍（CAPD）。此外,ACCs可以记录在有助听器的儿童身上，听觉脑干植入物，和人工耳蜗,和ACC结果可以指导听力干预/康复策略。审查发现，进行ACC测量所需的时间通常很长；为儿童开发更有效的ACC测试程序将是有益的。客观的ACC测量值与声音辨别的行为测量值之间的比较显示出某些显着的相关性，但不是全部,包括研究。
结论：ACC测量区分语音和非语音的神经能力在婴儿和儿童中是可行的，并且存在广泛的可能的临床应用，虽然时间更有效的程序将有利于临床摄取。建议考虑年龄和成熟效应，需要进一步研究以调查客观ACC措施与声音和言语感知的行为措施之间的关系，以便有效地进行临床实施。
方法：在儿童（<18岁）中进行ACC测量的原始同行评审文章。数据被提取和总结为：（1）参与者特征;（2）ACC方法和听觉刺激;（3）与ACC技术性能相关的信息;（4）ACC测量结果，优势,和挑战。使用PRISMA报告指南进行系统审查，并评估纳入文章的方法学质量。
结果：共确定了28项研究（9项婴儿研究）。审查结果表明，ACC反应可以测量婴儿（从<3个月），有证据表明年龄依赖性，包括随着儿童年龄的增加，ACC反应的稳健性增加。临床应用包括测量听力损失儿童的言语和非言语声音辨别的神经能力，听觉神经病变谱系障碍（ANSD）和中枢听觉处理障碍（CAPD）。此外,ACCs可以记录在有助听器的儿童身上，听觉脑干植入物，和人工耳蜗,和ACC结果可以指导听力干预/康复策略。审查发现，进行ACC测量所需的时间通常很长；为儿童开发更有效的ACC测试程序将是有益的。客观的ACC测量值与声音辨别的行为测量值之间的比较显示出某些显着的相关性，但不是全部,包括研究。
结论：ACC测量区分语音和非语音的神经能力在婴儿和儿童中是可行的，并且存在广泛的可能的临床应用，虽然时间更有效的程序将有利于临床摄取。建议考虑年龄和成熟效应，需要进一步研究以调查客观ACC措施与声音和言语感知的行为措施之间的关系，以便有效地进行临床实施。
