PP1107 - To Sedate or Not to Sedate: Utilizing the Audiologist's Diagnostic Toolbelt Efficiently to Reduce Sedated ABR Over-Referrals

Abstract:
Behavioral audiologic testing may yield limited results for difficult to test populations. This can lead to numerous repeat audiology appointments or recommendation for sedated auditory brainstem response (ABR) testing *** This project utilized distortion product otoacoustic emissions (DPOAE) in combination with limited behavioral test results to determine audiologic follow-up recommendations for this population.  The goals of this project are to avoid excessive audiology appointments and over-referring for sedated ABR testing to reduce the risk of repeat anesthesia, especially for young children.

Summary:
The purpose of this project is to develop an efficient plan to manage difficult to test populations when behavioral testing yields to limited results so as to reduce the burden of multiple appointments on families and limit repeat exposure to anesthesia for young children.

A survey was sent to all audiologists within the Division of Audiology at Cincinnati Children’s Hospital Medical Center inquiring about follow-up recommendations for patients where limited behavioral test results were obtained. A response rate of 75% was obtained. Results revealed that follow-up recommendations varied among audiologists and were influenced by the subjective and objective results obtained.

A chart review was completed of forty-seven patients where limited behavioral and objective data was obtained and a comprehensive hearing evaluation was not able to be completed. All forty-seven patients underwent sedated ABR testing. Prior to sedated ABR testing, forty-one patients were suspected to have normal hearing, and six patients were suspected to have hearing loss based on the presence or absence of DPOAE results and/or SAT/SRT results obtained. For all forty-seven patients, limited behavioral test results include only obtaining a SRT/SAT and unable to obtain responses to tonal stimuli or grossly abnormal responses when compared to the SRT/SAT.  DPOAEs were also attempted to be obtained for all patients. 46% of patients were referred for sedated ABR testing after the first limited behavioral hearing test.  44% were referred after two limited behavioral hearing tests and 10% had 3 or greater limited behavioral hearing tests.

Based on the chart review, DPOAEs may be a predictor of normal or near normal hearing sensitivity and audiologists may defer a recommendation for a sedated ABR and continue monitoring behaviorally.  95% of patients who had normal DPOAE results in both ears had normal ABR test results.  One patient was found to have auditory neuropathy spectrum disorder (ANSD), and one had an abnormal ABR at 2000 Hz’ which two follow-up behavioral hearing tests revealed normal hearing at all frequencies (250-8000 Hz).  All 6 patients who had abnormal DPOAE results were found to have permanent hearing loss and were fit with hearing aids.  Of the 95% of patients who had normal ABR results, 30% were referred again to audiology by their Primary Care Physician or specialist (Speech Pathologist or Developmental Pediatrician).  Of those 75% had a successful behavioral hearing test.  The average time from the sedated ABR to successful behavioral hearing test was 23 months.

From this data, follow-up recommendation guidelines were established to reduce the burden on families of overscheduling and limit unnecessary exposure to anesthesia with a decreased likelihood of missing permanent hearing loss.