LM203 - Sedated Auditory Electrophysiologic Testing: Recommendations for Best Practices and Lessons Learned

Abstract:
Auditory electrophysiologic (AEP) testing under sedation, while an invaluable clinical tool, can have limitations, be subject to electrical interference, and can be difficult to interpret in complex cases. This session will provide an in-depth look into sedated AEP testing basics, best practices, and case studies. The presenters will review challenging and unique case studies in patients with complex medical histories, important information in the differential diagnosis of various types of auditory disorders, and recommendations for troubleshooting in adverse situations.

Summary:
Sedated auditory electrophysiologic (AEP) testing is utilized to estimate hearing sensitivity and peripheral auditory function in individuals who are either too young or not otherwise able to participate in behavioral testing. This valuable clinical tool can serve to identify, confirm, or disprove auditory disorders in some of our most complex patient populations. While the value of this testing is well known, certain challenges can occur during testing including electrical interference/equipment limitations (Sauter, et al, 2012), outer or middle ear disorders (Dietrich, et al, 2012), and confounding medical variables (Gundogdu, et al, 2022). Collectively, these challenges require the need for specialized knowledge and skills to arrive at a definitive diagnosis.

This intermediate learning module will review the basics, best practices, and case studies related to sedated AEP testing. Challenging and unique case studies in patients with complex medical histories will be presented and discussed. The presenters will also review important information in the differential diagnosis of sensorineural hearing loss vs. conductive hearing loss vs. auditory dyssynchrony vs. cochlear nerve deficiency and beyond.

References
Dietrich M, Schade H, Nadal J, Keiner S, Schade G. Clinical Decision Making for Intraoperative Auditory Brainstem Response Testing in Children following Tympanostomy Tube Placement. J Clin Med. 2023 Jan 20;12(3):830. doi: 10.3390/jcm12030830. PMID: 36769478; PMCID: PMC9917660.

Gundogdu O, Yaman H, Karaaslan P, Serbetcioglu MB. Effect of General Anesthesia on Auditory Brainstem Response Testing. Medeni Med J. 2022 Jun 23;37(2):145-149. doi: 10.4274/MMJ.galenos.2022.25741. PMID: 35734981; PMCID: PMC9234361.

Sauter B.T., Douglas L.B., Speidel P.D. ABR and ASSR: Challenges and Solutions, 2012 Hearing Review. 2012;19(06):20-25.

Brief Summary of Clinical Takeaways:
The clinical takeaways for this session include:

Best practices in sedated auditory electrophysiologic testing.
Troubleshooting during testing in order to achieve optimal results.
Using advanced knowledge to arrive at definitive clinical diagnoses.