Hearing screening is only the first step in the care of a hearing-impaired infant. Programs need to ensure that families understand the necessity of follow-up testing without creating undue stress. The transition to early intervention should be seamless, with a cohesive team of health care professionals capable of providing medical, audiologic, communication, and educational management for the infant as well as emotional support for the family.

Background To eliminate the medical risks and logistical challenges of transporting infants from the neonatal intensive care unit (NICU) to the radiology department for magnetic resonance imaging, a small-footprint 1.5-T MRI scanner has been developed for neonatal imaging within the NICU. MRI is known to be noisy, and exposure to excessive acoustic noise has the potential to elicit physiological distress and impact development in the term and preterm infant. Objective To measure and compare the acoustic noise properties of the NICU MRI system against those of a conventional 1.5-T MRI system. Materials and methods We performed sound pressure level measurements in the NICU MRI scanner and in a conventional adult-size whole-body 1.5-T MRI system. Sound pressure level measurements were made for six standard clinical MR imaging protocols. Results The average sound pressure level value, reported in unweighted (dB) and A-weighted (dBA) decibels for all six imaging pulse sequences, was 73.8 dB and 88 dBA for the NICU scanner, and 87 dB and 98.4 dBA for the conventional MRI scanner. The sound pressure level values measured on the NICU scanner for each of the six MR imaging pulse sequences were consistently and significantly (P=0.03) lower, with an average difference of 14.2 dB (range 10–21 dB) and 11 dBA (range 5–18 dBA). The sound pressure level frequency response of the two MR systems showed a similar harmonic structure above 200 Hz for all imaging sequences. The amplitude, however, was appreciably lower for the NICU scanner, by as much as 30 dB, for frequencies below 200 Hz. Conclusion The NICU MRI system is quieter than conventional MRI scanners, improving safety for the neonate and facilitating siting of the unit within the NICU.

Objective To study normative thresholds and latencies for click and tone-burst auditory brainstem response (TB-ABR) for air and bone conduction in normal infants and those discharged from neonatal intensive care units (NICU), who passed newborn hearing screening and follow-up DPOAE. An evoked potential system (Vivosonic Integrity™) that incorporates Bluetooth electrical isolation and Kalman-weighted adaptive processing to improve signal to noise ratios was employed for this study. Results were compared with other published data. Research Design One hundred forty-five infants who passed two-stage hearing screening with transient-evoked otoacoustic emission (OAE) or automated ABR were assessed with clicks at 70 dB nHL and threshold TB-ABR. Tone-bursts at frequencies between 500 to 4000 Hz were employed for air and bone conduction ABR testing using a specified staircase threshold search to establish threshold levels and Wave V peak latencies. Results Median air conduction hearing thresholds using TB-ABR ranged from 0-20 dB nHL, depending on stimulus frequency. Median bone conduction thresholds were 10 dB nHL across all frequencies, and median air-bone gaps were 0 dB across all frequencies. There was no significant threshold difference between left and right ears and no significant relationship between thresholds and hearing loss risk factors, ethnicity or gender. Older age was related to decreased latency for air conduction. Compared to previous studies, mean air conduction thresholds were found at slightly lower (better) levels, while bone conduction levels were better at 2000 Hz and higher at 500 Hz. Latency values were longer at 500 Hz than previous studies using other instrumentation. Sleep state did not affect air or bone conduction thresholds. Conclusions This study demonstrated slightly better Wave V thresholds for air conduction than previous infant studies. The differences found in the current study, while statistically significant, were within the test step size of 10 dB. This suggests that threshold responses obtained using the Kalman weighting software were within the range of other published studies using traditional signal averaging, given step-size limitations. Thresholds were not adversely affected by variable sleep states.

CM and SPs can be readily measured using standard click stimuli in both well and NICU infants. Normative ranges for latency and amplitude are useful for interpreting ECochG and ABR components. Inclusion of ECochG and ABR tests in a test battery that also includes otoacoustic emission and acoustic reflex tests may provide a more refined assessment of the risks of AN and SNHL in infants.

BACKGROUND: Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children. METHODS: This prospective double-blind crossover study enrolled children (≤18 years old) receiving general anesthesia for elective ABR testing. All subjects received both sevoflurane and propofol anesthesias in the same ABR testing session. Deidentified ABR data were reviewed by 5 audiologists (blinded to anesthetic and patient) to determine threshold levels for hearing loss. The primary outcome was qualitative interpretability (false positive) of ABR click-testing. RESULTS: Each patient was tested at 4 different intensities in each ear: generating 624 records under each anesthetic, for a total of 1248 records. A few patients were tested at 5 different intensities in a single ear accounting for the additional 11 records, yielding 1259 records. Under sevoflurane anesthesia, 21 of the same patients (37 ears) were identified with abnormal ABR levels consistent with hearing loss (one or both ears). The probability of a patient being diagnosed with hearing "loss" in one or both ears was significantly less with propofol versus sevoflurane anesthesia (mid P =.0312). If patients with bilateral loss are compared, the mid P value is 0.0098. The effect size based on patients was medium to large, with a minimum value of Cohen w = 0.320. CONCLUSIONS: Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children. (Anesth Analg 2022;134:802-9) KEY POINTS• Question: Does the anesthetic agent used during auditory brainstem response (ABR) testing for hearing impairment in children influence interpretability of results? • Findings: Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. • Meaning: Anesthetic regimens can lead to significant alteration in interpretability of ABR testing children-use of sevoflurane may cloud interpretability, and propofol seems to be a preferable anesthetic agent. GLOSSARYABR = auditory brainstem response; ASA = American Society of Anesthesiologists; AUC = area under the curve; CONSORT = Consolidated Standards of Reporting Trials; D/C = discontinue; IV = intravenous; MAC = minimum alveolar concentration; nHL = normal adult hearing level; SVM = support vector machine versions of this article on the journal's website (www.anesthesia-analgesia. org).

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