Analysis of Factors Related To Head MRI Changes In Neonatal Hyperbilirubinemia And Effect On Neurodevelopmental Outcomes.

Abstract Background and ObjectiveThis study aims to detect how hyperbilirubinemia affects cerebral structures by imagery (MRI) to prevent irreversible future brain damage. Research Design and MethodsIn this retrospective study, 50 infants of 35 weeks gestation or more with hyperbilirubinemia were assigned to two groups based on abnormal or normal head imaging (MRI). The primary outcomes included peak bilirubin levels according to socio-demographic factors and how these levels influence MRI.The secondary outcome was neurodevelopment at 1, 3, 6, 9 and 12 months for the imaging changes versus the normal imaging groups assessed by a combined formulaire based on the CDC’s developmental milestones, the Denver II Developmental Screening Test (DDST), the Hammersmith infant neurological exam, and auditory brainstem response (ABR) by investigators. ResultsPeak serum bilirubin levels (TSB) in the group with MRI changes, defined as bilaterally symmetrical signal intensity on T1- weighted imaging in the globus pallidus GP, was significantly higher than those in the group without MRI changes (342.5±47.6μmol/L vs. 284.3±46.3μmol/L), p=0.000. Odds ratios when observing TSB values with 342μmol/L as cut-off, showed that participants with TSB ≥ 342μmol/L were 12.4 times more likely of presenting with abnormal MR imaging (OR=12.4, 95% CI 2.191-70.672). In addition, a cross-tab comparison between MRI and milestones depicts MRI as having a 66.7% ，33.3% sensitivity and specificity while 12.5%，97.1% PPV (positive predictive value) and NPV (negative predictive values) respectively for milestone attainment. No relationship was found between abnormal outcomes and abnormal MRI. ConclusionsA significant relationship between high bilirubin levels and head imaging (MRI) was observed, but these changes in imaging could not significantly predict neurodevelopmental outcomes.

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Efficiency of Stenger test in confirming profound, unilateral pseudohypacusis

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004769 ◽

2009 ◽

Vol 123 (8) ◽

pp. 840-844 ◽

Cited By ~ 8

Author(s):

A Durmaz ◽

S Karahatay ◽

B Satar ◽

H Birkent ◽

Y Hidir

Keyword(s):

Hearing Loss ◽

Auditory Brainstem Response ◽

Gold Standard ◽

Pure Tone Audiometry ◽

Auditory Brainstem ◽

Profound Hearing Loss ◽

Predictive Values ◽

Brainstem Response ◽

Sensitivity Specificity ◽

Response Testing

AbstractObjective:Conscious and deceptive exaggeration of hearing loss is termed pseudohypacusis. Even though the Stenger test has been used in the management of pseudohypacusis for almost a century, its sensitivity, specificity and predictive values for unilateral pseudohypacusis have not previously been reported, to our best knowledge. We investigated the efficiency of the Stenger test in detecting unilateral pseudohypacusis, accepting auditory brainstem response testing as the ‘gold standard’.Materials and methods:Candidates with questionable profound or total hearing loss were enrolled in the study. Pure tone audiometry, speech and tonal Stenger tests, and click test auditory brainstem response measurement were performed. Accepting auditory brainstem response testing as the gold standard, the sensitivity, specificity and predictive values of the Stenger test for unilateral, profound pseudohypacusis were assessed.Results:Two hundred military candidates were enrolled in the study. The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99.4 and 70 per cent, respectively. The positive and negative predictive values of the test were 87.5 and 98.4 per cent, respectively.Conclusion:The Stenger test is widely used for the evaluation of unilateral or asymmetrical pseudohypacusis. In our opinion, it is a powerfully reliable test. More difficult cases require objective electrophysiological testing to verify functional hearing loss and to exclude specific diagnoses that may imitate pseudohypacusis.

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Prognostic value of newborn hearing screening in patients with myelomeningocele

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14168 ◽

2014 ◽

Vol 14 (5) ◽

pp. 495-500 ◽

Cited By ~ 2

Author(s):

David Satzer ◽

Daniel J. Guillaume

Keyword(s):

Neonatal Intensive Care ◽

Auditory Brainstem ◽

Hearing Screening ◽

Newborn Hearing Screening ◽

Predictive Values ◽

Prognostic Assessment ◽

Brainstem Dysfunction ◽

Newborn Hearing ◽

Surgical History ◽

Brainstem Response

Object Brainstem dysfunction occurs in a minority of patients with myelomeningocele (MMC), most of whom have Chiari Type II malformation. Some surgeons advocate early identification of these patients for craniocervical decompression to avoid significant mortality. The auditory brainstem response has been found to be abnormal in most children with MMC. The present study examines whether failure of routine newborn hearing screening (NHS) predicts brainstem dysfunction in MMC patients. Methods The charts of 40 newborns with MMC and 50 newborns without MMC who stayed in the neonatal intensive care unit were reviewed. Results of NHS, brainstem symptoms, birth demographics, and surgical history were retrospectively examined. Differences in the presence and onset of brainstem symptoms by NHS result were assessed. Results Failure of NHS was more common among newborns with MMC who developed brainstem symptoms (31%, 4 of 13 patients) than among newborns without MMC (0%, 0 of 50 patients; p = 0.001). Among the 40 newborns with MMC, brainstem symptoms were more common in those who failed NHS (80%, 4 of 5 patients) than in those who passed (26%, 9 of 35 patients; p = 0.031). Respiratory symptom onset occurred later in patients who failed NHS (median 16 months) than among those who passed (median 0 months; p = 0.022). The positive and negative predictive values of NHS for brainstem dysfunction in MMC were 0.80 and 0.74, respectively. Conclusions Results of NHS may help predict future brainstem dysfunction in patients with MMC and may be useful to incorporate into prognostic assessment and surgical decision making.

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Hit and False-Alarm Rates of Selected ABR Indices in Differentiating Cochlear Disorders From Acoustic Tumors

American Journal of Audiology ◽

10.1044/1059-0889.0501.90 ◽

1996 ◽

Vol 5 (1) ◽

pp. 90-96 ◽

Cited By ~ 4

Author(s):

Frank E. Musiek ◽

Cynthia A. McCormick ◽

Raymond M. Hurley

Keyword(s):

False Alarm ◽

Amplitude Ratio ◽

High Specificity ◽

Auditory Brainstem ◽

Latency Difference ◽

Cochlear Pathology ◽

Brainstem Response ◽

Absolute Latency ◽

Two Indices ◽

Low Sensitivity

We performed a retrospective study of 26 patients with acoustic tumors and 26 patients with otologically diagnosed cochlear pathology to determine the sensitivity (hit rate), specificity (false-alarm rate), and efficiency of six auditory brainstem response indices. In addition, a utility value was determined for each of these six indices. The I–V interwave interval, the interaural latency difference, and the absolute latency of wave V provided the highest hit rates, the best A’ values and good utility. The V/I amplitude ratio index provided high specificity but low sensitivity scores. In regard to sensitivity and specificity, using the combination of two indices provided little overall improvement over the best one-index measures.

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The Effect of Kalman-Weighted Averaging and Artifact Rejection on Residual Noise During Auditory Brainstem Response Testing

American Journal of Audiology ◽

10.1044/2018_aja-18-0123 ◽

2019 ◽

Vol 28 (1) ◽

pp. 114-124

Author(s):

Linda W. Norrix ◽

Julie Thein ◽

David Velenovsky

Keyword(s):

Repeated Measures ◽

Auditory Brainstem ◽

Weighted Averaging ◽

Auditory Brainstem Responses ◽

Residual Noise ◽

Electrophysiological Recordings ◽

Artifact Rejection ◽

Brainstem Response ◽

Active Motor ◽

Averaging Time

Purpose Low residual noise (RN) levels are critically important when obtaining electrophysiological recordings of threshold auditory brainstem responses. In this study, we examine the effectiveness and efficiency of Kalman-weighted averaging (KWA) implemented on the Vivosonic Integrity System and artifact rejection (AR) implemented on the Intelligent Hearing Systems SmartEP system for obtaining low RN levels. Method Sixteen adults participated. Electrophysiological measures were obtained using simultaneous recordings by the Vivosonic and Intelligent Hearing Systems for subjects in 2 relaxed conditions and 4 active motor conditions. Three averaging times were used for the relaxed states (1, 1.5, and 3 min) and for the active states (1.5, 3, and 6 min). Repeated-measures analyses of variance were used to examine RN levels as a function of noise reduction strategy (i.e., KWA, AR) and averaging time. Results Lower RN levels were obtained using KWA than AR in both the relaxed and active motor states. Thus, KWA was more effective than was AR under the conditions examined in this study. Using KWA, approximately 3 min of averaging was needed in the relaxed condition to obtain an average RN level of 0.025 μV. In contrast, in the active motor conditions, approximately 6 min of averaging was required using KWA. Mean RN levels of 0.025 μV were not attained using AR. Conclusions When patients are not physiologically quiet, low RN levels are more likely to be obtained and more efficiently obtained using KWA than AR. However, even when using KWA, in active motor states, 6 min of averaging or more may be required to obtain threshold responses. Averaging time needed and whether a low RN level can be attained will depend on the level of motor activity exhibited by the patient.

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Comparisons of Auditory Brainstem Responses Between a Laboratory and Simulated Home Environment

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-20-00383 ◽

2020 ◽

Vol 63 (11) ◽

pp. 3877-3892

Author(s):

Ashley Parker ◽

Candace Slack ◽

Erika Skoe

Keyword(s):

Home Environment ◽

Signal To Noise Ratio ◽

Auditory Brainstem ◽

Auditory Brainstem Responses ◽

Single Family ◽

Adult Participants ◽

Simulated Home Environment ◽

Brainstem Response ◽

Research Populations ◽

Response Consistency

Purpose Miniaturization of digital technologies has created new opportunities for remote health care and neuroscientific fieldwork. The current study assesses comparisons between in-home auditory brainstem response (ABR) recordings and recordings obtained in a traditional lab setting. Method Click-evoked and speech-evoked ABRs were recorded in 12 normal-hearing, young adult participants over three test sessions in (a) a shielded sound booth within a research lab, (b) a simulated home environment, and (c) the research lab once more. The same single-family house was used for all home testing. Results Analyses of ABR latencies, a common clinical metric, showed high repeatability between the home and lab environments across both the click-evoked and speech-evoked ABRs. Like ABR latencies, response consistency and signal-to-noise ratio (SNR) were robust both in the lab and in the home and did not show significant differences between locations, although variability between the home and lab was higher than latencies, with two participants influencing this lower repeatability between locations. Response consistency and SNR also patterned together, with a trend for higher SNRs to pair with more consistent responses in both the home and lab environments. Conclusions Our findings demonstrate the feasibility of obtaining high-quality ABR recordings within a simulated home environment that closely approximate those recorded in a more traditional recording environment. This line of work may open doors to greater accessibility to underserved clinical and research populations.

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Objective Assessment of Hearing in Children: Update on Procedures and Protocols

Perspectives on Hearing and Hearing Disorders in Childhood ◽

10.1044/hhdc21.2.50 ◽

2011 ◽

Vol 21 (2) ◽

pp. 50-58

Author(s):

James W. Hall ◽

Anuradha R. Bantwal

Keyword(s):

Psychosocial Development ◽

Otoacoustic Emissions ◽

Objective Assessment ◽

Behavioral Assessment ◽

Auditory Brainstem ◽

Test Battery ◽

Auditory Evoked Responses ◽

Brainstem Response ◽

Assessment Techniques ◽

Pediatric Populations

Early identification and diagnosis of hearing loss in infants and young children is the first step toward appropriate and effective intervention and is critical for optimal communicative and psychosocial development. Limitations of behavioral assessment techniques in pediatric populations necessitate the use of an objective test battery to enable complete and accurate assessment of auditory function. Since the introduction of the cross-check principle 35 years ago, the pediatric diagnostic test battery has expanded to include, in addition to behavioral audiometry, acoustic immittance measures, otoacoustic emissions, and multiple auditory evoked responses (auditory brainstem response, auditory steady state response, and electrocochleography). We offer a concise description of a modern evidence-based audiological test battery that permits early and accurate diagnosis of auditory dysfunction.

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