Barriers to auditory brainstem response testing under anesthesia

• Published in: International journal of pediatric otorhinolaryngology Vol. 186; p. 112124
• Main Authors: Tunkel, Alexandra E., Benbourenane, Anisa, Behzadpour, Hengameh K., Rana, Md Sohel, Ambrose, Tracey, Kronzek, Eve, Preciado, Diego A., Reilly, Brian K.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-11-2024
• Subjects: ABR; Auditory brainstem response; Hearing loss; Pediatric hearing loss; ABR; Pediatric hearing loss; Auditory brainstem response; Hearing loss
• ISSN: 0165-5876; 1872-8464; 1872-8464
• DOI: 10.1016/j.ijporl.2024.112124

Auditory brainstem response (ABR) testing is the gold standard for diagnosis of hearing loss in children who cannot complete behavioral audiometry. Testing under general anesthesia is often recommended when natural sleep ABR and/or behavioral audiometry are unsuccessful. This study aims to determine which demographic and patient factors serve as barriers to receiving this diagnostic testing.
A retrospective chart review from an internal database of patients who underwent ABR testing under anesthesia from 2017 to 2023 was completed. Patient demographics, clinical diagnoses, dates of initial recommendation, and dates of testing were recorded.
A total of 395 patients met inclusion criteria, with a median time from initial evaluation to successful ABR under anesthesia of 5.1 months (range 0.1–209 months). This time was significantly higher in patients with public insurance compared to private insurance and in patients with the following medical complexities: cardiac disease, developmental delay, neurologic disease, eye disease, and genetic syndromes not associated with hearing loss. The interval was significantly shorter in patients with abnormal ear anatomy.
Patient factors, such as insurance type and certain medical diagnoses, may lead to delayed ABR testing under anesthesia and thus delayed diagnosis and management of hearing loss. This has implications for the timely care and treatment of children with hearing loss.
•Children with public insurance wait longer for ABR under anesthesia (70).•There is no difference in wait time based on sex, race, ethnicity, or state (63).•Medically complex children also experience delays in obtaining ABR under anesthesia (85).•Abnormal ear anatomy diagnosis leads to earlier ABR under anesthesia (71).