Pediatric hearing assessment by auditory brainstem response in the operating room

Int J Pediatr Otorhinolaryngol. 2011 Jul;75(7):935-8. doi: 10.1016/j.ijporl.2011.04.010. Epub 2011 May 14.


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.

MeSH terms

  • Adolescent
  • Auditory Threshold
  • Child
  • Child, Preschool
  • Evoked Potentials, Auditory, Brain Stem*
  • Female
  • Humans
  • Infant
  • Intraoperative Period
  • Male
  • Middle Ear Ventilation*
  • Myringoplasty*
  • Otitis Media with Effusion / physiopathology
  • Otitis Media with Effusion / surgery*