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Published on: January 23, 2017
The role of intraoperative auditory brainstem response testing for infants and difficult-to-test children
Joshua G Yorgason1, Albert H Park, Nanette Sturgill
1Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
Insights
Intraoperative auditory brainstem response (ioABR) testing showed significant discrepancies with later hearing evaluations in infants and children. Follow-up audiologic testing is recommended to confirm ioABR findings, especially if hearing loss is indicated.
Area of Science:
- Pediatric audiology
- Neuroscience
- Otolaryngology
Background:
- Intraoperative auditory brainstem response (ioABR) is used to monitor hearing during surgery.
- Its accuracy in infants and young children, particularly those with complex cases, requires further validation.
Purpose of the Study:
- To evaluate the reliability of ioABR compared to standard follow-up hearing assessments in pediatric patients.
- To determine if ioABR accurately predicts postoperative hearing outcomes.
Main Methods:
- A case series design with chart review was employed.
- Twenty-six pediatric patients underwent ioABR and subsequent hearing evaluations.
- Analysis focused on threshold changes, with a sub-analysis for middle ear fluid presence.
Main Results:
- A significant discrepancy was noted between ioABR and follow-up thresholds, particularly at 1 kHz.
- While many ears showed improvement, a notable percentage had middle ear fluid, potentially influencing ioABR results.
- A small proportion of ears demonstrated a 10-dB or worse threshold change, indicating potential inaccuracies.
Conclusions:
- Intraoperative auditory brainstem response (ioABR) results may not perfectly align with definitive hearing thresholds.
- Audiologic testing several weeks post-surgery is crucial for confirming ioABR findings, especially when initial results suggest hearing impairment.
Objective:
To assess the validity of intraoperative auditory brainstem response in infants and difficult-to-treat older children.
Study Design:
Case series with chart review.
Setting:
Tertiary-level children's hospital.
Subjects And Methods:
Twenty-six patients were identified (mean age, 20 +/- 18 months) who underwent both intraoperative auditory brainstem response (ioABR) testing and a follow-up hearing evaluation at five (standard deviation 4) months. Ears were analyzed separately for mean threshold change, and a sub-analysis was performed accounting for the presence or absence of fluid at the time of surgery.
Results:
A paired t test analysis indicated a statistically significant difference at 1 kHz. There was not a statistically significant difference between the two groups with click or 4-kHz testing. Fifteen ears (58%) at 1 kHz and 17 ears (49%) at 4 kHz frequencies, however, improved by 10 dB or more; 67 percent and 65 percent of these ears, respectively, had middle ear fluid intraoperatively. Eight ears (35%) in the click ABR group had a similar improvement, four of which had fluid at the time of surgery. Four ears in the 1-kHz (11.5%), in the 4-kHz (11.4%), and in the click ABR group (17.4%) demonstrated a 10-dB or worse threshold. The range of the discrepancy varied from a worsening in thresholds up to 20 dB and improvement in thresholds up to 45 dB.
Conclusions:
We observed a significant discrepancy between ioABR and follow-up hearing thresholds. If ioABR indicates a hearing loss, audiologic testing should be performed at least several weeks later to confirm the results.
