Making ABR

fast, accurate Response amplitudes

and clear!
typically 50% larger
than tone burst
responses, with the
potential to halve the
test time

CE-Chirp®
Stimulus Family
The Gold standard
for threshold
assessment

hirp® LS
Stimulus Family
“Our work has shown that narrow-
band CE-Chirps® offer frequency-
specific testing in typically half the
time taken by tone pips. Given that a
sleeping baby is a ticking time bomb
waiting to go off, that’s an advantage
you can’t afford to pass up. It’s
frustrating that not all ABR systems
offer this stimulus.*”
Guy Lightfoot PhD 2013
 The Challenge:
Identifying
wave V close
to threshold
The CE-Chirp® stimulus
family
• Traditional CE-Chirp® & NB
CE-Chirp® from 2007 &
current CE-Chirp® LS Family
• NB CE-Chirp® LS family (2014)
• All with normative data
Difficult and time consuming included
testing
Correctly diagnosing the type and degree
of hearing loss so that rehabilitation can
occur, is one of the most important roles
of an audiologist or physician.

Click and tone burst ABR have been

successfully used for many years, but
despite their common clinical use these
stimuli are associated with long test
times and small wave V amplitudes. This
results in ABR traces which are difficult to
A preview of the
interpret, leading clinicians to have less benefits of the CE-Chirp®
confidence in what they see on screen. stimulus family
• Response amplitudes
typically 50% larger than
tone burst responses, with
The solution the potential to halve the
Large ABR waveforms are dependent on test time
synchronous neural firing. • Easier interpretation
Unfortunately, click and tone burst stimuli • Reduced test time
are not designed to stimulate the cochlea • Increased confidence
optimally. As the cochlea is tonotopically
organised, the different frequency
components of the click and tone bursts
reach their point of stimulation on the
basilar membranes at different times. This
leads to temporal smearing of the ABR
result shown on screen. The solution to
this problem is to design a stimulus which
stimulates all the desired frequencies of
the basilar membrane at the same time.

2
The Solution:
CE-Chirp ®

stimulus family
Compensating for
the cochlear delay
The CE-Chirp® stimulus family was
developed following many years of
extensive human studies by numerous
researchers including Claus Elberling, the
researcher who the CE-Chirp® has been
named in honor of.
For an easier visual evaluation of the
Narrow Band (NB) CE-Chirp® responses,
each of the NB CE-Chirp® stimuli have
been time-shifted to provide latencies
similar to the Click and the CE-Chirp® LS
stimulus. The time-shifted NB CE-Chirp®
are named NB CE-Chirp® LS, as the
placements are level specific.
The similarities between the CE-Chirp® Click stimulus CE-Chirp® LS stimulus

LS and the Click lie in the spectrum and

These studies determined the delay calibration of the stimuli, while the dif-
1
Elberling, C., & Don, M. (2008). Auditory
model that had the best match for the brainstem responses to a chirp stimulus
ference lies in the presentation timing of
average human cochlea; the outcome designed from derived-band latencies in
the low, mid and high frequency compo- normal-hearing subjects. J Acoust Soc Am,
being the innovative CE-Chirp®. For the nents of the stimulus in order to provide 124, 3022-3037.
clinician this means larger amplitude greater neural synchronization.
waveform responses allowing for easier
threshold identification1. In 2007,
Interacoustics was the first company to
introduce the revolutionary CE-Chirp®
Click versus CE-Chirp® Stimulus
into a diagnostic evoked potentials
platform leading to markedly reduced Click Threshold CE-Chirp® LS Threshold
test time and easier interpretation for
the clinician. Response amplitudes up
to twice the size when compared with
traditional clicks or tone bursts can be
achieved with both the broadband CE-
Chirp® and frequency specific narrow
band CE-Chirps® . The CE-Chirp® LS
stimulus family is an overall improvement
to the original CE-Chirp® stimulus family.

While the original broadband CE-Chirp®

was designed for optimal response
amplitudes at medium stimulation
intensities, the level specific (LS)
broadband CE-Chirp® provides clearer Comparison of click and broadband CE-Chirp® LS stimulus amplitudes and latencies.
waveform morphology at high and low The wave V amplitudes are larger with the broadband CE-Chirp® LS.
intensities.

3
 The Proof:
Is in the
waveforms
Learn more about the clinical
advantages of the CE-Chirp® family
at www.interacoustics.com

ABR threshold
with NB CE-Chirps®
CE-Chirp®
Stimulus Family NB CE-Chirps® ABR is a fast,
accurate tool for estimating
The Gold standard the hearing threshold. These
for threshold UK NHSP results are essential for the
assessment approved* diagnostic evaluation.

Comparison of ABR response

*certified for use in the UK newborn hearing
screening programme.
amplitude, test time, and
estimation of hearing
threshold using frequency
specific chirp and tone pip
stimuli in newborns.
(Ferm, Lightfoot & Stevens, 2013)

Results & Conclusion:

Overall, NB CE-Chirp® responses were 64%
larger than the tone pip responses. Fmp
was significantly higher for NB CE-Chirps®.

It is anticipated that there could be

significant reductions in test time for the
same signal to noise ratio by using NB CE-
Chirps® when testing newborns.

*tone bursts are also referred to as tone pips.

4
 Tone burst versus NB-CE-Chirp® stimulus
The waveforms are for 4 different babies all ≤8 weeks corrected age. Courtesy of Inga Ferm.
Average
responses for
500Hz Tone Burst vs 500Hz NB CE-Chirp® 1kHz Tone Burst vs 1kHz NB CE-Chirp®
100nv/div 100nv/div
4 frequencies
were 50%
larger

50 35

40 25

30 Comparison of 500Hz tone burst and 500Hz NB CE-Chirp® 15 Comparison of 1kHz tone burst and 1kHz NB CE-Chirp®
responses. responses. Larger
response
dBnHL dBnHL
amplitudes.
2kHz Tone Burst vs 2kHz NB CE-Chirp ®
4kHz Tone Burst vs 4kHz NB CE-Chirp® Reduces test
100nv/div 100nv/div time

30 40

20 30

Comparison of 2kHz tone burst and 2kHz NB CE-Chirp® Comparison of 4kHz tone burst and 4kHz NB CE-Chirp®
10 responses. 20 responses.

dBnHL dBnHL

Further comparisons of
Comparing auditory brainstem
ABR response amplitudes,
Guidelines for the early responses (ABRs) to toneburst
test time, and estimation
audiological assessment and narrow band CE-chirp® in
of hearing threshold using
and management of babies young infants.
frequency-specific chirp and
tone pip stimuli in newborns: referred from the Newborn (Rodrigues, Ramos & Lewis, 2013)
Findings at 0.5 and 2 kHz. Hearing Screening Program.
(Stevens, Sutton & Wood (eds), 2013) Conclusion:
(Ferm & Lightfoot, 2015)
Narrow band CE-chirp® ABRs generate
Narrow band chirps are now acceptable shorter latencies than the toneburst
Conclusion:
as an alternative to tone pips for ABR ABRs, especially to low frequencies.
The advantages of NB CE-Chirps® over
testing, with nHL to eHL correction Higher amplitudes were found with
tone pips* we previously identified at
values being provided. narrow band CE-chirp® stimuli for all
4 and 1 kHz extends to 0.5 and 2 kHz,
The two advantages of using chirps are: frequencies tested, except to high levels.
which supports the use of NB CE-Chirps®
when testing newborns. We propose that • The ABR response is usually larger

ABR nHL threshold to eHL corrections for which should reduce test time

NB CE-Chirps should be approximately

® (Ferm et al., 2013; Elberling & Don,

5 dB less than corrections for tone 2010).

pips at 0.5 and 2 kHz, mirroring our • The confidence intervals for the eHL

recommendation at 4 and 1 kHz. threshold value are smaller.

5
 NB CE-Chirps® ASSR threshold
The NB CE-Chirp® ASSR was
developed by Cebulla,
Stürzebecher and Elberling
(2006) and has demonstrated
up to 50% faster detection and
even more accurate hearing
thresholds compared to earlier
generation ASSR systems.
Furthermore, the results of NB
CE-Chirp® ASSR are optimized
for hearing aid fitting.
The following articles
highlight the benefits and
usability of the CE-Chirp®
stimulus family in clinical
testing.
Average
test time
18 minutes
6 4000 Hz.
Refining the audiological
assessment in children using
narrow-band CE-Chirp®-
evoked auditory steady state
responses
(Venail et al., 2014)
Conclusions:
Narrow-band CE-Chirps® allow a fast
and reliable assessment of auditory
thresholds in children, especially in the
low-frequency range, by comparison
with other stimuli.
Fast Hearing-Threshold
Estimation Using Multiple
Auditory Steady-State
Responses with Narrow-Band
Chirps and Adaptive Stimulus
Patterns
(Mühler, Mentzel & Verhey, 2012)
Conclusions:
The average differences between the
behavioural hearing thresholds and the
ASSR threshold estimate were 10, 8, 13,
and 15 dB for test frequencies of 500,
1000, 2000, and 4000 Hz, respectively.
The average overall test duration of 18.6
minutes for the threshold estimations
at the four frequencies and both ears
demonstrates the benefit of an adaptive
recording algorithm and the efficiency of
optimized narrow-band chirp stimuli.
Auditory Steady-State Evoked
Responses for Preterm and
Term Neonates
(Ribeiro, Carvallo & Marcoux, 2010)
Conclusions:
Significant threshold differences were
measured between the groups at 500
and 4000 Hz, while the thresholds at
1000 and 2000 Hz were similar.
These results indicate that ASSRs can
be effectively measured with a similar
signal-to-noise ratio in both groups, but
that there is a significant maturational
effect occurring during gestation at the
level of structures, which participates in
the formation of the ASSR at 500 and
21 minutes
average
test time
Establishing auditory steady-
state response thresholds to
narrow band CE-chirps® in
full-term neonates
(Rodrigues, G. R., & Lewis, D. R., 2014)
Conclusions:
In this study ASSR thresholds estimated
from 90% of the neonates were 34.5, 28,
12.5 and 15 dB nHL. It required 21,2 (±5)
min on average to obtain thresholds in
each ear and ASSR thresholds to narrow
band CE-chirp® in neonates are not
significant for adult ASSR thresholds,
except at 500 Hz, when the ASSR
thresholds in neonates tend to be
greater than in adults.
Threshold prediction in chil-
dren with sensorioneural
hearing loss using the audi-
tory steady-state responses
and tone-evoked auditory
brain stem response
(Rodrigues & Lewis, 2010)
Conclusions:
Multiple ASSRs have strong correlations
to tone-evoked ABR and to behavioral
thresholds obtained during follow-up
in hearing impaired infants and young
children. These results might be useful in
order to provide further evidence for the
use of multiple ASSRs, as an alternative
tool to tone-evoked ABR, although
further data are still required.

Learn more about the CE-
Chirp® stimulus family at
www.interacoustics.com/
eclipse
Stimulus Family
“Our work has shown that narrow-
band CE-Chirps® offer frequency-
specific testing in typically half the
time taken by tone pips. Given that a
sleeping baby is a ticking time bomb
waiting to go off, that’s an advantage
you can’t afford to pass up. It’s
frustrating that not all ABR systems
offer this stimulus.*”
Guy Lightfoot PhD 2013
References & Suggested Reading
Articles
Cebulla, M., Stürzebecher, E., &
Elberling, C. (2006).
Objective detection of auditory steady-
state responses: Comparison of one-
sample and q-sample tests.
J Am Acad Audiol, 17(2), 93–103.
Elberling, C., Don, M., Cebulla, M., &
Stürzebecher, E. (2007).
Auditory steady-state responses to chirp
stimuli based on cochlear traveling wave
delay.
J Acoust Soc Am, 122(5), 2772-2785.
Ferm, I., & Lightfoot, G. J. (2015).
Further comparisons of ABR response
amplitudes, test time, and estimation
of hearing threshold using frequency-
specific chirp and tone pip stimuli in
newborns: Findings at 0.5 and 2 kHz.
Int J Audiol, 54(10), 745-750.
Ferm, I., Lightfoot, G., & Stevens, J.
(2013).
Comparison of ABR response amplitude,
test time, and estimation of hearing
threshold using frequency specific chirp
and tone pip stimuli in newborns.
Int J Audiol, 52(6), 419-423.
Kristensen, S.G., & Elberling, C. (2012).
Auditory brainstem responses to level-
specific chirps in normal-hearing adults.
J Am Acad Audiol, 23(9), 712–721.
Mühler, R., Mentzel, K., & Verhey, J.
(2012).
Fast hearing-threshold estimation using
multiple auditory steady-state responses
with narrow-band chirps and adaptive
stimulus patterns.
The Scientific World Journal, 2012:192178.
Ribeiro, F. M., Carvallo, R. M., &
Marcoux, A. M. (2010).
Auditory steady-state evoked responses
for preterm and term neonates.
Audiol Neurootol, 15(2), 97-110.
Ribeiro, F. M., Chapchap, M. J., & Leite,
R. A. (2011).
Chirp-ASSR thresholds for normal hearing
term and preterm neonates. Presented
at the International Evoked Response
Audiometry Study Group (IERASG)
Conference, Moscow, Russia.
Rodrigues, G. R., & Lewis, D. (2010).
Threshold prediction in children with
sensorioneural hearing loss using
the auditory steady-state responses
and tone-evoked auditory brain stem
response.
Int J Pediatric Otorhinolaryngol, 74(5),
540-546.
Rodrigues, G. R., Ramos, N., & Lewis, D.
R. (2013).
Comparing auditory brainstem responses
(ABRs) to toneburst and narrow band CE-
Chirp® in young infants.
Int J Pediatr Otorhinolaryngol, 77(9), 1555-
1560.
Rodrigues, G. R., & Lewis, D. (2014)
Establishing auditory steady-state
response thresholds to narrow band CE-
chirps® in full-term neonates. Int J Pediatr
Otorhinolaryngol, 78(2), 238-243.
Stevens, J. Sutton & G. Wood, S (Eds)
(2013).
Guidelines for the early audiological
assessment and management of babies
referred from the Newborn Hearing
Screening Programme, V3.1
http://www.thebsa.org.uk/wp-
content/uploads/2014/08/NHSP_
NeonateAssess_2014.pdf
Sutton, G. and Lightfoot, G. (Eds) 2013
Guidance for Auditory Brainstem
Response testing in Babies, V 2.1
http://www.thebsa.org.uk/wp-
content/uploads/2014/08/NHSP_
ABRneonate_2014.pdf
Venail, F., Artaud, J. P., Blanchet, C.,
Uziel, A., & Mondain, M. (2015).
Refining the audiological assessment in
children using narrow-band CE-Chirp-
evoked auditory steady state responses.
Intl J Audiol, 54(2), 106-113.
7
 Where is the CE-Chirp® stimulus family
available?
Todd B. Sauter, M.A.
Audiology Associates of
Database
Worcester Massachusetts NOAH OtoAccess TM
“The Eclipse has the largest Data Storage Data Storage
number of clinically-relevant OAE & Sharing & Sharing
ABR
features of any AEP device today.
The platform is an excellent DPOAE20 EP25 *
blend of parameter flexibility Screening and ABR, MLR, LLR, P300,
clinical DPOAE MMN, ECochG, eABR
and user-friendliness.”
TEOAE25 EP15 *
Screening and ABR
clinical TEOAE

Balance
ABRIS
Automated ABR
screening

VEMP
ASSR *
cVEMP
oVEMP Threshold assessment
The Eclipse
*The CE-Chirp® stimulus family is included in the EP25 and
ASSR and is optional for the EP15 software for the Eclipse.

Database
NOAH OtoAccessTM
Data Storage Data Storage
& Sharing & Sharing

Interacoustics A/S
OAE ABR
Audiometer Allé 1
DPOAE440 ABRIS440 *
5500 Middelfart
Denmark Screening and Automated ABR
clinical DPOAE infant screening
The Titan

Impedance
T +45 6371 3555
TEOAE440
F +45 6371 3522
Screening and
clinical TEOAE
info@interacoustics.com
IMP440
interacoustics.com
Screening, diagnostic
& clinical impedance

*The original CE-Chirp® and the special HiLo CE-Chirp® are

included in the ABRIS440 automated ABR software for the Titan.

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