Whether A Positive Response at approximately 4.5 ms in Auditory Brainstem Response Signifies Cochlear Nerve Deficiency in Infants?

Abstract

Objectives In 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.

Design This 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.

Results In 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.

Conclusions Our 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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by grants from the National Natural Science Foundation of China (grant 81700903 to BL), Clinical Research Plan of SHDC (shdc12020105) and Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This was a retrospective study, and it was approved by the Translational Medicine Ethics Review Committee of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine (SH9H-2022-T378-1).

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Footnotes

Financial disclosures/conflicts of interest: This work was supported by grants from the National Natural Science Foundation of China (grant 81700903 to BL), Clinical Research Plan of SHDC (shdc12020105) and Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300). There are no conflicts of interest, financial, or otherwise.

Data Availability

All data produced in the present work are contained in the manuscript

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