A Positive Response around 4.6 ms in Auditory Brainstem Response in Cochlear Nerve Deficiency Infants

Abstract

ObjectivesIn the auditory brainstem response (ABR) tests, the regular V wave was absent, and a positive response at approximately 4.5 ms latency (IV’ wave) was observed at high intensity level (80 to 95 dB) in some infants in our center. Those infants presenting the IV’ wave was always diagnosed with cochlear nerve deficiency (CND). The profile of the IV’ wave was summarized. The relationship between the IV’ wave and CND was also explored.DesignThis was a retrospective study. The click ABR recordings of all infants who visited our center between February 2017 and December 2021 were reviewed. The inclusion criteria included profound hearing loss (ABR threshold>95 dB) on at least one side. The exclusion criteria included age older than 36 months, tympanogram type B, specific ear trauma and infection history, other acquired hearing loss disease and no imaging examinations of the inner ear taken in our hospital. In total, 355 individuals were included. A total of 140 individuals had profound hearing loss in one ear, and 215 had profound hearing loss in both ears. Data were analyzed by ear and further grouped by CND diagnosis according to the inner ear imaging and IV’ wave according to the click ABR recording.ResultsIn the 355 patients, the IV’ wave was observed in 53 ears. Of the 53 ears that presented with the IV’ wave, 52 ears were diagnosed with CND. The other 76 ears were diagnosed with CND and showed no IV’ wave. The positive predictive value of the IV’ wave for CND was 98.11%. The sensitivity of the IV’ wave to CND was 40.63%. The amplitude of the IV’ wave dropped significantly as the sound intensity decreased to 85 dB. The latency of the IV’ wave ranged from 3.87 to 5.19 ms, averaged 4.58±0.189 ms at 95 dB, and barely prolonged as the sound intensity decreased.ConclusionsOur study demonstrated that the regular V wave was absent and a 4.5 ms positive response was observed at high intensity level in the ABR tests in some infants. The IV’ wave showed an excellent positive predictive value for CND. The IV’ wave specifically presented in infants with CND has the potential to be a new indicator for the CND population.