Brainstem Auditory Evoked Potentials' Diagnostic Accuracy for Hearing Loss: Systematic Review and Meta-Analysis.
BackgroundMicrovascular decompression (MVD) utilizes brainstem auditory evoked potential (BAEP) intraoperative monitoring to reduce the risk of iatrogenic hearing loss. Studies report varying efficacy and hearing loss rates during MVD with intraoperative monitoring.ObjectivesThis study aims to perform a comprehensive review and study of diagnostic accuracy of BAEPs during MVD to predict hearing loss in studies published from January 1984 to December 2013.MethodsThe PubMed/MEDLINE and World Science databases were searched. Studies performed MVD for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia or geniculate neuralgia and monitored intraoperative BAEPs to prevent hearing loss. Retrospectively, BAEP parameters were compared with postoperative hearing. The diagnostic accuracy of significant change in BAEPs, which includes loss of response, was tested using summary receiver operative curve and diagnostic odds ratio (DOR).ResultsA total of 13 studies were included in the analysis with a total of 2,540 cases. Loss of response pooled sensitivity, specificity, and DOR with 95% confidence interval being 74% (60-84%), 98% (88-100%), and 69.3 (18.2-263%), respectively. The similar significant change results were 88% (77-94%), 63% (40-81%), and 9.1 (3.9-21.6%).ConclusionPatients with hearing loss after MVD are more likely to have shown loss of BAEP responses intraoperatively. Loss of responses has high specificity in evaluating hearing loss. Patients undergoing MVD should have BAEP monitoring to prevent hearing loss.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Parthasarathy D
PD
Thirumala
Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Gregory
G
Carnovale
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Yoon
Y
Loke
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Miguel E
ME
Habeych
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Donald J
DJ
Crammond
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Jeffrey R
JR
Balzer
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Raymond F
RF
Sekula
auditory; brainstem; evoked potentials; glossopharyngeal nerve diseases; hearing loss; hemifacial spasm; trigeminal neuralgia