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Effect of Tympanostomy Tube Placement on Intraoperative Auditory Brainstem Response
Aleksandra Martinovic1, Jessica Chen1, Kayla Sivas2
1Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah.
Insights
Intraoperative auditory brainstem response (ioABR) testing in children may be affected by tympanostomy tube insertion, especially when middle ear fluid is present. Further research is needed to confirm these findings.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Neuroscience
Background:
- Intraoperative auditory brainstem response (ioABR) testing is crucial for pediatric audiological assessments when other methods are unreliable.
- Previous studies suggest potential confounding results from tympanostomy tube (TT) insertion during ioABR.
Purpose of the Study:
- To evaluate if temporary threshold shift (TTS) occurs after tympanostomy tube (TT) placement in children undergoing ioABR testing.
- To investigate the impact of TT insertion on auditory brainstem response (ABR) thresholds in pediatric patients.
Main Methods:
- A prospective case-control study involving 20 children (38 ears) undergoing combined TT and ioABR procedures.
- Comparison of ABR thresholds (2 and 4 kHz tone bursts) before and after TT insertion, with recording of middle ear status.
- Paired t-test used for statistical significance analysis.
Main Results:
- No statistically significant difference in ABR thresholds was found overall before and after TT placement.
- However, 50% of patients with mucoid middle ear fluid showed a 10 dB or greater worsening in ABR thresholds.
- Twenty-nine percent of patients with serous fluid also exhibited a similar worsening in ABR thresholds.
Conclusions:
- Middle ear fluid (mucoid or serous) may influence ABR thresholds following TT insertion in children.
- ioABR results obtained immediately after TT placement in the presence of middle ear fluid should be interpreted cautiously.
- Larger sample size studies are required to validate these preliminary findings.
Background:
Intraoperative auditory brainstem response (ioABR) testing under general anesthesia is commonly performed on children when sleep-deprived ABR and behavioral testing are not reliable or feasible. Several studies have reported potential confounding results when tube insertion is combined with ABR testing.
Purpose:
This article evaluates whether a temporary threshold shift (TTS) occurs following placement of tympanostomy tubes (TTs) in children who undergo ioABR testing.
Research Design:
A case-control prospective study. Patients scheduled for combined TT and ioABR procedures were enrolled into this study.
Study Sample:
Twenty children (38 ears), ranging in age from 6 months to 10.5 years, were enrolled.
Data Collection And Analysis:
ABR thresholds for tone bursts with center frequencies of 2 and 4 kHz were compared before and after tube insertion. The indication for surgery, comorbidities, and status of the middle ear were also recorded. A paired t-test was used to determine statistical significance.
Results:
Data collection did not necessarily indicate suctioning and tube placement were causing a TTS; however, fluid present in the middle ear space prior to TT placement appeared to influence results. Although a paired t-test did not show statistically significant differences in ABR thresholds between groups of individuals with and without fluid and before and after tube placement, 50% of patients with mucoid fluid (two out of four patients) were noted to have 10 dB or greater worsening in ABR thresholds in two out of six ears. Twenty-nine percent of patients with serous fluid (two out of seven patients) were noted to have at least a 10 dB worsening in ABR threshold in 2 out of 10 ears. Further testing is needed to confirm these trends.
Conclusion:
This pilot study indicates that children with mucoid or serous fluid may experience worse ABR thresholds following TT insertion. ioABR testing immediately after TT tube placement and in the presence of middle ear fluid should be interpreted with caution. Additional studies with a larger sample size are needed to confirm these results.
