Auditory Steady-State Responses in Adults Aged 88–95 Years Measured in a Home Setting: Feasibility and Agreement with Pure-Tone Audiometry

Background/Objectives: Hearing assessment may be challenging in individuals of very advanced age when cognitive or physical limitations restrict participation in behavioural testing or access to clinic-based hearing care. This study evaluated the suitability of auditory steady-state responses (ASSRs) as a clinical method for assessing peripheral hearing in individuals of very advanced age by examining its agreement with pure-tone audiometry (PTA) thresholds and its feasibility in a home setting among individuals aged 88–95 years. Methods: Home visits were conducted for 91 individuals, of whom 71 completed the behavioural and electrophysiological test protocol and were included in the analyses. ASSR thresholds at 0.5, 1, 2, and 4 kHz were compared with corresponding PTA thresholds for the right and left ears. Agreement was assessed using Bland–Altman analyses, with differences within ±15 dB considered clinically acceptable. Reasons for unobtained ASSR thresholds were systematically recorded. The Mini-Mental State Examination (MMSE) was administered, and PTA–ASSR threshold differences were compared using a cut-off score of ≤26 for cognitive impairment. Results: ASSR thresholds were within ±15 dB of the corresponding PTA thresholds in 92% of right ears and 85% of left ears. Mean differences were close to 0 dB at most frequencies, although greater differences were observed at 0.5 and 1 kHz in the left ear. The mean ASSR test duration was 21.5 min. ASSR thresholds were unobtainable in 31% of PTA–ASSR comparisons, most commonly because of high rejection rates related to EEG and/or myogenic activity and participant discomfort. PTA–ASSR threshold differences did not differ significantly between MMSE groups (≤26 vs. >26). Conclusions: ASSR offers a promising alternative for hearing assessment in individuals of very advanced age who may have difficulty participating in behavioural testing. Furthermore, the results suggest that ASSR can be performed in home settings, including nursing homes and residential care facilities. Participant comfort and positioning are important for reducing muscular artefacts and improving measurement feasibility.