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Clinical Decision Making for Intraoperative Auditory Brainstem Response Testing in Children following Tympanostomy
Maria Dietrich1, Heike Schade2, Jennifer Nadal3
1Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Insights
Temporary threshold shifts can affect intraoperative auditory brainstem response (ioABR) tests in children. Mucoid middle ear fluid significantly increases the risk of prolonged wave I latencies, indicating a potential air-bone gap.
Area of Science:
- Otolaryngology
- Audiology
- Pediatric Surgery
Background:
- Intraoperative auditory brainstem response (ioABR) testing is used after tympanostomy tube (TT) placement.
- Temporary threshold shifts (TTS) may bias ioABR results.
- Prolonged wave I latency is a marker for a persisting air-bone gap.
Purpose of the Study:
- To assess evidence of TTS in children undergoing ioABR.
- To identify factors contributing to prolonged wave I latencies post-TT placement.
Main Methods:
- ioABR testing was performed on 83 children (163 ears) at University Hospital Bonn.
- Wave I latency at 80-dB SPL was the primary outcome.
- Presence and type of middle ear fluid (none, serous, mucoid) were recorded.
Main Results:
- A higher risk of prolonged wave I latency was observed in ears with mucoid fluid (OR 4.61, p < 0.001).
- The sample included 66 males and 17 females, with mean age 46.4 months.
- 44.2% of ears had no fluid, 11.6% serous, and 44.2% mucoid fluid.
Conclusions:
- ioABR results in children require careful interpretation, considering sex differences and middle ear status.
- Mucoid fluid significantly increases the likelihood of prolonged latencies, suggesting an air-bone gap.
- Preoperative counseling is crucial to discuss postponing ioABR if mucoid fluid is present.
Abstract:
Intraoperative auditory brainstem response (ioABR) testing following tympanostomy tube (TT) placement may be biased due to temporary threshold shifts (TTS). The purpose of the study was to assess the evidence for TTS in children who have undergone ioABR using prolonged latencies of wave I (males > 1.95 ms, females > 1.88 ms) as a marker of a persisting air-bone gap. Eighty-three children underwent ioABR following surgical procedures at University Hospital Bonn, Germany. The primary outcome measure was the latency of wave I at 80-dB SPL. The total sample consisted of 66 males (79.5%) and 17 females (20.5%) with a mean (SD) age of 46.4 (26.6) months. Of 163 operated ears (83 children), 72 (44.2%) had no middle ear fluid, 19 (11.6%) serous fluid, and 72 (44.2%) mucoid fluid. The risk of having a prolonged latency of wave I at 80-dB SPL was OR 4.61 (95% CI 2.01-10.59; p < 0.001) in those with mucoid fluid as compared to those without mucoid fluid. Intraoperative ABR results should account for sex differences and be interpreted with caution and be verified. Ultimately, parents should be engaged in a preoperative discussion to decide if an ioABR should be postponed if mucoid fluid was found.
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