PubMed · 6837367
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K Terkildsen, P Osterhammel. 1983. Brainstem electrical response audiometry.. https://doi.org/10.1159/000407486
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The preservation of hearing is a major aim of contemporary temporal bone surgery. Our present findings demonstrate that intraoperative monitoring is a key method for attaining serviceable postoperative hearing after the removal of an acoustic neuroma. Both electrocochleography (ECoG) and brainstem electrical response audiometry were performed in 96 patients operated on for acoustic neuromas. The specificity of the different monitoring methods was affected by surgical manipulations in addition to such non-specific influences as CSF drainage, core body temperature and anesthesia. In the present study ECoG was found to be more reliable in assessing the intra- and postoperative course with respect to the preservation of cochlear function.
The diagnosis of retrocochlear damage is supported by an increased latency difference between peak I and peak V. In case of high frequency hearing loss peak I is often hard to determine, and peak V latency may be shifted not only by neural delay, but also by missing basal hair cells. The amount of cochlear delay can be estimated by a procedure presented here. High frequency decay was simulated by steep high-pass noise masking. Peak V latency turned out to be established by the highest unaffected frequency components of the click stimulus. Thus, in case of a high frequency gap (with normalization towards higher frequencies) latency may be almost normal. In case of prolonged latency the amount ascribable to the cochlea may be rather precisely be estimated. If the whole lag is explained this way, unnecessary further diagnostics can be avoided.
The purpose of this study was the evaluation of evoked otoacoustic emissions (EOAE) for the screening of infant hearing. EOAE and brainstem-evoked response audiometry (BERA) were performed in 40 infants at a special care unit at the Universitäts-Klinik, Göttingen. Both examinations were performed under non-optimal conditions, reflecting a realistic screening situation. The purpose was to determine robust analysis criteria and possible error sources. A comparison of both tests shows that sensitivity and specificity are insufficient for reliable screening. The EOAE test does not yield the threshold of hearing. There is no sharp boundary with the BERA threshold for the detectability of an EOAE. Sensitivity and specificity have not been accurately determined so far due to the relatively small number of infants with impaired hearing tested. Nevertheless, the results show that EOAE should be applied as a supplement to conventional audiometry for infants. It is capable of excluding conductive and severe cochlear hearing losses and is by itself not a reliable screening test.