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Published on: July 1, 2015
Pediatric hearing assessment by auditory brainstem response in the operating room
Briana Dornan1, Brian Fligor, Kenneth Whittemore
1Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, United States.
Insights
Auditory brainstem response (ABR) testing in the operating room (OR) may show elevated hearing thresholds, especially with middle ear effusion. Follow-up evaluations are crucial for accurate hearing assessment in pediatric patients.
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.
Objectives:
To investigate the factors contributing to the discrepancies between auditory brainstem response (ABR) thresholds obtained in the operating room (OR) and hearing outcomes obtained in the follow-up period and to explore the benefits and limitations of performing ABR in the OR.
Methods:
A retrospective review study was conducted in a pediatric tertiary care facility. A total of 116 patients were identified with complete records, including OR-ABR results, medical examination and surgical procedure notes, and follow-up medical/audiological evaluation. Patients were divided into three groups: (1) 58 patients with middle ear effusion underwent myringotomy and tube placement, (2) 12 patients underwent myringotomy without tube placement, (3) 46 patients underwent ear examination only without effusion found. OR-ABR results were compared to audiological follow-up evaluations and analyzed for each group.
Results:
In patients with middle ear effusion and tube placement, the average threshold difference between OR-ABR and follow-up audiological evaluation was 9.7 dB (± 12.7), with highest discrepancy of 45 dB. On the other hand, in patients with dry ears and/or no tube placement, the average threshold difference was only 3.8 dB (± 8.6). Moreover, the discrepancy was more prominent in patients with mucoid effusion and larger at lower frequency, i.e., 1000 Hz.
Conclusions:
The hearing thresholds estimated by ABR testing in the OR can be elevated and follow-up hearing evaluation after tube placement is needed. While ABR testing is valuable in the assessment of pediatric patients, especially for children who are difficult-to-test or have complicated medical conditions, caution should be taken when interpreting OR-ABR results.
