Melatonin is a Useful Alternative to Sedation in Children Undergoing Brainstem Audiometry with an Age Dependent Success Rate - A Field Report of 250 Investigations

Abstract

Though brainstem audiometry is one of the most important investigations in pediatric audiology, it often necessitates sedation or general anaesthetics, especially in newborns and infants. Melatonin, inducing natural sleep without the risks of sedation, has been successfully used to induce sleep prior to EEG investigations. 250 children (142 male, 108 female) with suspected hearing loss underwent ABR (auditory brainstem responses) tests in melatonin-induced sleep. Click-induced and notched-noise ABR tests were performed. Click tests were successfully performed in 216 of 249 children or 86.7% (123 male, 93 female), notched-noise tests in 115 of 155 children or 74.2%. Failure rates showed an age dependence increasing from 4% in children <1 year to 25%>3 years, but no gender difference. In conclusion, melatonin-induced sleep is a good alternative to sedation, especially in children younger than 3 years. This method is widely accepted by parents and permits earlier diagnosis of hearing impairment in a routine clinical setting. The number of children undergoing general anaesthesia for ABR investigation was reduced from over 60 per year in 2000-2002 to 12 in 2005, which means >80% less general anaesthesia.

The Use of Melatonin for Sedation During Auditory Brainstem Response Testing: An Alternative to Sedation in Non-Medical Settings?

“…This indicated that reliable and valid ABR could be recorded under both test conditions; which was a positive finding in the current study indicating that melatonin did not induce negative effects on morphology, repeatability and amplitudes of ABR in compliant adults with normal hearing. These findings exclude melatonin from pharmacological agents which are reported to affect the ABR 9 and support findings by Schmidt et al 8 which show that melatonin does not negatively affect the ABR waveform. To ensure reliability of these findings, a randomized double blind analysis strategy was adopted; and an independent rater was also utilized to establish Cohen's kappa (inter-rater agreement).…”

“…24 Audiologically, the use of melatonin was explored in 250 children with suspected hearing loss in Germany. 8 In that study, findings indicated that melatonininduced sleep is appropriate for the completion of ABR recordings in the paediatric population; whilst simultaneously eliminating the medical risks of conventional sedatives. The current study aimed to explore this and examine possible effects on the ABR response as well.…”

“…5 Sedation is therefore usually required for those patients who are restless during ABR testing to ensure control over artifacts. 8 It allows for the reduction of noise during ABR measurements, in order for reliable recordings to be obtained. 4 Evidence has shown that sedation does not affect the ABR; 2 and that most drugs and pharmacological agents have no negative influence on the ABR waveform, allowing for them to be utilised as sedatives during testing.…”

“…Melatonin requires 20 -120 minutes to take-effect and is reported to be non-toxic and does not normally cause negative side effects in healthy individuals 15 and children. 8 Moreover, clear contraindications for the use of the drug have been documented; 16 and additionally, medical monitoring is not required. 8 Long term use of melatonin has also not shown major side-effects.…”

“…8 Moreover, clear contraindications for the use of the drug have been documented; 16 and additionally, medical monitoring is not required. 8 Long term use of melatonin has also not shown major side-effects. 17,18 The most frequently reported side effects of melatonin are "hangover effects", 13 drowsiness, dizziness, nausea, and headaches, 19 fatigue, 20 and decreased concentration.…”