Improving Hearing in Stapedectomy With Intraoperative Auditory Brainstem Response

Abstract

Objective. To determine the efficacy of using intraoperative auditory brainstem response (ABR) in improving immediate hearing results of patients undergoing primary laser stapedotomy. Study Design. Case series with chart review. Setting. Community hospital. Subjects and Methods. The study included 32 consecutive patients, with 34 ears undergoing primary stapedotomy by a single surgeon at a single institution using a single prosthesis design. Intraoperative ABR was performed at the beginning of each surgery and after the stapes prosthesis was inserted. Surgical adjustments were made if initial ABR results did not demonstrate hearing improvement. ABR then was repeated at the conclusion of the procedure. Audiometry was performed postoperatively in all patients. Results. There were 22 left ears and 12 right ears studied. Two patients underwent bilateral staged surgery. Eight patients, or 23% of the group, had intraoperative adjustments made to improve hearing results. Hearing was improved in 33 of 34 ears, or 97%. The surgical revision rate was 3%. The average preoperative air-bone gap (ABG, calculated as an average from 250, 500, and 1000 Hz) was 29.0 dB HL in the left ear group and 26.6 dB HL in the right ear group. The average postoperative ABG was 9.9 dB HL in the left ear group and 9.4 dB HL in the right ear group. All patients had postoperative audiometric results consistent with final intraoperative ABR results. Conclusion. Intraoperative ABR may significantly improve immediate hearing results in patients and greatly reduce the need for revision surgery.