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Tone-pip frequency-specific auditory brainstem response via loudspeakers in ossiculoplasty: a tool in predicting long-term hearing improvement intra-operatively
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  • Wei Ren,
  • Fei Ji,
  • Cong Xu,
  • Fan-Jun Zheng,
  • Ying Yang,
  • Xiao Ren,
  • Pei-yi Jiang,
  • Bin-Yu Shi,
  • hui zhao,
  • Shi-Ming Yang
Wei Ren
Chinese PLA General Hospital
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Fei Ji
Chinese PLA General Hospital
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Cong Xu
Chinese PLA General Hospital
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Fan-Jun Zheng
Chinese PLA General Hospital
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Ying Yang
Chinese PLA General Hospital
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Xiao Ren
Chinese PLA General Hospital
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Pei-yi Jiang
Chinese PLA General Hospital
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Bin-Yu Shi
Chinese PLA General Hospital
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hui zhao
Chinese PLA General Hospital
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Shi-Ming Yang
Chinese PLA General Hospital
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Abstract

Objective: In this study, we aimed to establish a frequency-specific ABR (fs-ABR) system via loudspeakers to assess the hearing improvement in ossiculoplasty intra-operatively and observe its efficiency and accuracy in predicting the long-term outcome. Setting Blackman-gated 1kHz tone-pips with 1ms, 2ms and 3ms duration were used in normal hearing (NH) subjects to calibrate the system and the standard ABR threshold and wave V latency for this system were established. All subjects would take four hearing tests: Pure tone audiometry (PTA) before and six-month after the surgery, fs-ABR under anesthesia before surgery and right after the ossicular chain reconstruction intra-operatively. PTA was used as the standard test to measure hearing. Bland-Altman analysis and linear correlation analysis were used to compare the agreement between PTA and fs-ABR results. Participants Forty-two conductive hearing loss (CHL) subjects. Results: For NH and CHL subjects in operating room before surgery, the fs-ABR threshold showed a high linear relation with the PTA results (r=0.88, P<.0001). For CHL follow up results: for 1ms group, PTAI showed a better correlation with fs-ABRI (r=0.67, P<.01) with the equation: PTAI=2.15*fs-ABRI-3.49; for 3ms group, PTA showed a better correlation with fs-ABR (r=0.76, P<.01) with the equation PTA=0.93*fs-ABR+3.48. Bland-Altman analysis showed no difference between PTA and fs-ABR in all above analysis. Eustachian tube malfunction would negatively affect the prediction efficacy, for subjects with normal ETF, the correlation between fs-ABRI and PTAI was even higher: PTAI=1.6*fs-ABRI+12.48 with r=0.77 (P=.0407<0.05). Conclusions This system could monitor the function of the reconstructed ossicular chain intra-operatively and predict the post-surgical 6-month hearing improvement efficiently and accurately. The average testing time for the fs-ABR was short, about 10 to 15 minutes. This system would serve as a promising tool clinically to help surgeons optimize the efficacy of ossiculoplasty. Besides, ETF should be taken into consideration as a risk factor that would negatively influence the hearing impairment.