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Stability of ABR Wave V Threshold in Early Hearing Diagnostics in Children from Selected Groups at Risk of Congenital
Sebastian Kocoń1, Konrad Skórkiewicz2, Paweł Stręk1
1Chair and Clinic of Otolaryngology, Jagiellonian University, Collegium Medicum, Cracow.
Insights
The auditory brainstem response (ABR) test shows fluctuating results in infants with hearing loss risk factors, particularly those with cleft palate. This variability impacts treatment planning for congenital hearing disorders.
Area of Science:
- Pediatric audiology
- Neonatal screening
- Congenital hearing disorders
Background:
- Auditory Brainstem Response (ABR) testing is crucial for assessing hearing thresholds in infants.
- Variability in ABR wave V threshold results can delay diagnosis and intervention for hearing loss.
- Identifying specific risk groups with unstable ABR results is key for effective management.
Purpose of the Study:
- To analyze the stability of the auditory brainstem response (ABR) wave V threshold during the first year of life.
- To compare ABR threshold stability in infants with different congenital hearing disorder risk factors.
- To inform diagnostic and therapeutic strategies for pediatric hearing loss.
Main Methods:
- Retrospective analysis of ABR test results from 250 infants within the first year of life.
- Inclusion of four risk groups: Down syndrome, neurological conditions, cleft lip/palate, and congenital cytomegalovirus (CMV).
- Evaluation of ABR wave V threshold stability across four diagnostic periods.
Main Results:
- Infants with cleft palate exhibited the highest instability in ABR wave V thresholds.
- ABR result instability decreased over time in infants with Down syndrome.
- Infants with other nervous system conditions showed significant instability between early diagnostic periods.
- Infants with congenital CMV demonstrated relatively low ABR threshold instability.
Conclusions:
- The ABR test, while a standard, shows significant variability in specific pediatric groups, notably those with cleft palate, necessitating careful treatment planning.
- The high prevalence of hearing impairment (70%) in these at-risk groups validates the importance of newborn hearing screening.
- Understanding ABR variability aids in accurate interpretation and timely intervention for congenital hearing disorders.
Abstract:
<b>Introduction:</b> Upon hearing that the "little" patient has trouble with hearing, we are mostly interested in the level of his hearing threshold. When the child is in the first year of life, results can only be achieved by means of ABR test. Subsequent control tests, especially in children from the hearing loss risk groups selected in this study, show that the obtained outcomes are subject to fluctuations. Their fluctuating nature is manifested by the instability of wave V threshold in subsequent diagnostic periods. Such variability often delays the implementation of the appropriate proceeding. Knowledge of the dissimilarity of behavior of the wave V threshold occurring in individual groups at risk of hearing loss allows for the correct interpretation of the obtained results, and thus, effective therapeutic measures. <br><b>Aim:</b> The aim of the paper is to analyze the stability of wave V threshold during the first year of life in children from selected risk groups for congenital hearing disorders. <br><b>Material and methods:</b> From the patient population of 2,114 individuals examined in 2015-2016 at a reference center participating in the Universal Neonatal Hearing Screening Program in 2015-2016, the results of 250 children were subjected to retrospective analysis. Furthermore, 4 groups of little patients were formed (children with Down syndrome; children with other diseases or damage to the nervous system; children with cleft palate or cleft lip and cleft palate; children with congenital cytomegaly) in whom diagnostic practice revealed variable results of the wave V threshold. We analyzed the results of tests obtained during the first year of the child's life divided into 4 diagnostic periods. <br><b>Results:</b> The highest percentage of instability in the established threshold of wave V between individual diagnostic periods occurred in the group of children with cleft palate or cleft lip and cleft palate. In the group of children with Down syndrome, it was observed that the instability of the ABR test results decreased over time. In the group of children with other diseases or damage of the nervous system, the highest percentage of the lack of stable ABR wave V thresholds was observed between the 1st and 2nd as well the 1st and 4th diagnostic periods. On the other hand, in the group of children with congenital CMV, there was a relatively low percentage of instability of results. <br><b>Conclusions:</b> (1) Although the ABR test is a diagnostic standard, in particular groups of patients the study is burdened with high variability of measurement results in subsequent diagnostic periods. Such a group of patients are children with cleft palate or cleft lip and cleft palate; therefore, it must receive particular attention in treatment planning; (2) in selected groups at risk of hearing loss, due to the high percentage of children with hearing impairment (70%), the validity of performing newborn hearing screening tests was confirmed.
