Effect of Tympanostomy Tube Placement on Intraoperative Auditory Brainstem Response

Abstract

Background Intraoperative auditory brainstem response (ioABR) testing under general anesthesia is commonly performed on children when sleep-deprived ABR and behavioral testing are not reliable or feasible. Several studies have reported potential confounding results when tube insertion is combined with ABR testing.

Purpose This article evaluates whether a temporary threshold shift (TTS) occurs following placement of tympanostomy tubes (TTs) in children who undergo ioABR testing.

Research Design A case–control prospective study. Patients scheduled for combined TT and ioABR procedures were enrolled into this study.

Study Sample Twenty children (38 ears), ranging in age from 6 months to 10.5 years, were enrolled.

Data Collection and Analysis ABR thresholds for tone bursts with center frequencies of 2 and 4 kHz were compared before and after tube insertion. The indication for surgery, comorbidities, and status of the middle ear were also recorded. A paired t-test was used to determine statistical significance.

Results Data collection did not necessarily indicate suctioning and tube placement were causing a TTS; however, fluid present in the middle ear space prior to TT placement appeared to influence results. Although a paired t-test did not show statistically significant differences in ABR thresholds between groups of individuals with and without fluid and before and after tube placement, 50% of patients with mucoid fluid (two out of four patients) were noted to have 10 dB or greater worsening in ABR thresholds in two out of six ears. Twenty-nine percent of patients with serous fluid (two out of seven patients) were noted to have at least a 10 dB worsening in ABR threshold in 2 out of 10 ears. Further testing is needed to confirm these trends.

Conclusion This pilot study indicates that children with mucoid or serous fluid may experience worse ABR thresholds following TT insertion. ioABR testing immediately after TT tube placement and in the presence of middle ear fluid should be interpreted with caution. Additional studies with a larger sample size are needed to confirm these results.

Keywords

otitis media - intraoperative auditory brainstem response - tympanostomy tubes - temporary threshold shift - electrophysiology - clinical audiology

Note

This research was presented at the 2018 American Academy of Audiology conference in Nashville, TN.

Publikationsverlauf

Eingereicht: 18. April 2019

Angenommen: 18. Juni 2020

Artikel online veröffentlicht:
09. Dezember 2020

• References

• 1 Rosenfeld RM, Culpepper L, Doyle KJ. et al; American Academy of Pediatrics Subcommittee on Otitis Media with Effusion, American Academy of Family Physicians; American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: otitis media with effusion. Otolaryngol Head Neck Surg 2004; 130 (5, Suppl): S95-S118
• 2 Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics 1998; 102 (05) 1161-1171
• 3 Boone RT, Bower CM, Martin PF. Failed newborn hearing screens as presentation for otitis media with effusion in the newborn population. Int J Pediatr Otorhinolaryngol 2005; 69 (03) 393-397
• 4 Boudewyns A, Declau F, Van den Ende J. et al. Otitis media with effusion: an underestimated cause of hearing loss in infants. Otol Neurotol 2011; 32 (05) 799-804
• 5 Hood LJ. Auditory brainstem response: estimation of hearing sensitivity. In: Katz J, Chasin M, English K, Hood LJ, Tillery KL. eds. Handbook of Clinical Audiology. Philadelphia: Wolters Kluwer; 2015: 249
• 6 Houck CS, Vinson AE. Anaesthetic considerations for surgery in newborns. Arch Dis Child Fetal Neonatal Ed 2017; 102 (04) F359-F363
• 7 Warner DO, Zaccariello MJ, Katusic SK. et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology 2018; 129 (01) 89-105
• 8 Yorgason JG, Park AH, Sturgill N, Grimmer JF, Alder SC. The role of intraoperative auditory brainstem response testing for infants and difficult-to-test children. Otolaryngol Head Neck Surg 2010; 142 (01) 36-40
• 9 Wetmore RF, Henry WJ, Konkle DF. Acoustical factors of noise created by suctioning middle ear fluid. Arch Otolaryngol Head Neck Surg 1993; 119 (07) 762-766
• 10 Wang JC, Allen SJ, Rodriguez AI. et al. Measurement of the sound intensity during suction of middle-ear fluid following myringotomy. J Laryngol Otol 2014; 128 (07) 604-611
• 11 Hall JW. Manufacturer supplement eHandbook of auditory evoked responses. Vivosonic. 10; 2015
• 12 Mason JD, Mason SM, Gibbin KP. Raised ABR threshold after suction aspiration of glue from the middle ear: three case studies. J Laryngol Otol 1995; 109 (08) 726-728
• 13 Chambers RD, Rowan LE, Matthies ML, Novak MA. Auditory brain-stem responses in children with previous otitis media. Arch Otolaryngol Head Neck Surg 1989; 115 (04) 452-457
• 14 Griffiths H, James D, Davis R, Hartland S, Molony N. Hearing threshold assessment post grommet insertion. Is it reliable?. J Laryngol Otol 2007; 121 (05) 431-434
• 15 Zhou G, Dornan B, Hinchion W. Clinical experience of auditory brainstem response testing on pediatric patients in the operating room. Int J Otolaryngol 2012; 2012: 350437