Pediatric hearing assessment by auditory brainstem response in the operating room

Area of Science:

• Audiology
• Pediatric Otolaryngology
• Neuroscience

Background:

• Auditory brainstem response (ABR) is a key diagnostic tool for pediatric hearing assessment.
• Discrepancies between intraoperative ABR and follow-up hearing outcomes can impact patient management.
• Understanding factors influencing OR-ABR accuracy is essential for reliable pediatric audiological evaluations.

Purpose of the Study:

• To identify factors causing differences between operating room (OR) auditory brainstem response (ABR) thresholds and subsequent hearing outcomes.
• To evaluate the advantages and disadvantages of conducting ABR in the OR setting.

Main Methods:

• Retrospective review of 116 pediatric patients with complete audiological and surgical records.
• Comparison of OR-ABR results with follow-up audiological evaluations.
• Analysis of ABR data stratified by middle ear status (effusion, tube placement, dry ear).

Main Results:

• Patients with middle ear effusion undergoing tube placement showed an average OR-ABR to follow-up threshold difference of 9.7 dB, with a maximum discrepancy of 45 dB.
• Patients with dry ears or without tube placement had a smaller average difference of 3.8 dB.
• Threshold discrepancies were more pronounced in cases of mucoid effusion and at lower frequencies (1000 Hz).

Conclusions:

• Intraoperative ABR thresholds in pediatric patients can overestimate hearing loss, necessitating post-operative audiological assessment.
• OR-ABR is valuable for difficult-to-test children or those with complex conditions, but results require careful interpretation.
• Follow-up hearing evaluations are critical after procedures like myringotomy and tube placement to confirm true hearing status.