title: The role of intraoperative auditory brainstem response testing for infants and difficult-to-test children.
abstract: OBJECTIVE
  To assess the validity of intraoperative auditory brainstem response in infants and difficult-to-treat older children.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary-level children's hospital.
  
  
  METHODS
  Twenty-six patients were identified (mean age, 20 +/- 18 months) who underwent both intraoperative auditory brainstem response (ioABR) testing and a follow-up hearing evaluation at five (standard deviation 4) months. Ears were analyzed separately for mean threshold change, and a sub-analysis was performed accounting for the presence or absence of fluid at the time of surgery.
  
  
  RESULTS
  A paired t test analysis indicated a statistically significant difference at 1 kHz. There was not a statistically significant difference between the two groups with click or 4-kHz testing. Fifteen ears (58%) at 1 kHz and 17 ears (49%) at 4 kHz frequencies, however, improved by 10 dB or more; 67 percent and 65 percent of these ears, respectively, had middle ear fluid intraoperatively. Eight ears (35%) in the click ABR group had a similar improvement, four of which had fluid at the time of surgery. Four ears in the 1-kHz (11.5%), in the 4-kHz (11.4%), and in the click ABR group (17.4%) demonstrated a 10-dB or worse threshold. The range of the discrepancy varied from a worsening in thresholds up to 20 dB and improvement in thresholds up to 45 dB.
  
  
  CONCLUSIONS
  We observed a significant discrepancy between ioABR and follow-up hearing thresholds. If ioABR indicates a hearing loss, audiologic testing should be performed at least several weeks later to confirm the results.
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Yorgason
authors.forename: Albert H
authors.initials: AH
authors.lastname: Park
authors.forename: Nanette
authors.initials: N
authors.lastname: Sturgill
authors.forename: Johannes Fredrik
authors.initials: JF
authors.lastname: Grimmer
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Alder
mesh_terms: D016057:Evoked Potentials, Auditory, Brain Stem; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000175:diagnosis* / Q000503:physiopathology*; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D012189:Retrospective Studies