Abstract
OBJECTIVES: Auditory brainstem response (ABR) is the gold standard to assess hearing loss in pediatric patients. Multiple widely accepted ABR protocols with varying parameters are accepted, difference in standards may lead to misdiagnosis or delay in diagnosis and treatment. This study investigates the quality of ABR testing in pediatric patients in addition to changes in diagnoses and management. STUDY DESIGN: Retrospective chart review. SETTING: University Hospital, Rutgers New Jersey Medical School. METHODS: Retrospective chart review was conducted for all pediatric patients from 2012 to 2019 who had undergone prior outside ABR testing before presenting to our institution for hearing loss evaluation. The ABR tests were analyzed for completeness following the American Academy of Audiology (AAA), American Speech Language Hearing Association (ASHA), and The Joint Committee on Infant Hearing (JCIH) guidelines. Descriptive statistics on changes in patient diagnoses and interventions after repeat ABR were performed. RESULTS: 80 patients met inclusion criteria. The most common reasons for an incomplete ABR were inadequate components of testing including tone burst bone conduction (85.0%), polarity (82.5%), and tone burst air conduction (48.7%). 77 of the patients who presented required a repeat ABR. 37 repeated ABRs resulted in a change of diagnosis, the most common being from unspecified hearing loss to sensorineural hearing loss (10%). 23 cases had a change in ultimate management. CONCLUSION: Incomplete ABR testing may result in misdiagnosis, delay in diagnosis and treatment. Identifying common reasons for incomplete ABR testing may aid Otolaryngologists develop a screening workflow to recognize patients requiring repeat testing. LEVEL OF EVIDENCE: 4.