Expert: Harriet B Jacobster, Au.D. - 2/21/2009

Question
Hello,

I need help. I have had problems being diagnosed. I currently suffer from a muffled ear, intermitant tinitis, and loud shot gun sound going off in my ears when i sleep, i also have been suffering from intermittent left side face tingling and numbness, and eye pressure and pain in left eye. I have seen a Neuro doc he did a ABR test, (which he said will take 2 weeks to give me results, although he said it was unsatisfactory) I have a copy of the ABR test and i was wondering if you can tell me what the test means, I am worried about a AN possible. I just went to a ENT and they want to redo the ABR test. which is scheduled next week, but the muffle in my ears is driving me crazy with the headache and facial pain.
Okay the ABR right 1-5 in order is, 1.86, 2.70,3.82, 5.24,5.62.this is B-2 intervals in order are 1.96,3.76,1.80

ABR left in 1-5 in order is, 1.66,2.64,3.52,4.90,5.05 this is the A-1. intervals are ,1.86, 3.40, 1.54.

Also had a PR-VEP done and those results are,
Right stimulus both 16 a-1 96.6, A-3- 102.

Left stimulus is B-1 both 16 100, B-3 both 16 99.0

So my question is what does this all mean for me. I expertienced a awful, left eye muscle jerking and twitching during this test, and the tech told me to be still and i was. Neuro also did a EEG and Eye test, and a brain doppler. but will not get those test results back until march. Please help, i am at a lose and need some clarification i am not going crazy with the full ear and ear pain and facial problems.

Thanks for any input you have.

TinaMarie

Answer
Hi TinaMarie,
The ABR is a test of the integrity of the auditory nerve and its ability to properly transmit a signal. In interpreting an ABR, we measure the times (in milliseconds) it takes for a signal to reach certain points along the nerve as it travels from the ear to the brainstem.  We then compare the results from each ear to established norms to make sure the signal is traveling at a normal rate and we also compare both ears to each other to make sure the nerves are functioning symmetrically.  

Most ABRs done in a neurologist's office are not administered by an audiologist.  Only an audiologist is truly qualified to administer and interpret an ABR.  So, it is very good that you have chosen to see an ENT and have them redo the evaluation.

Next, there are many reasons for an asymmetry in the values in the ABR.  A very important reason is asymmetrical hearing due to either middle ear pathology (which can also cause many of your symptoms) or neural damage.  Without having had a complete audiological evaluation prior to the ABR, the test results of the ABR are not reliable. Therefore, a technician in a neurologist's office is not qualified to correctly administer or interpret these results without a valid audiological evaluation.

So, the best advice I can give you is to right now wait until you see the ENT and have a complete and valid otoneurological workup.

As for the VEP evaluations, that is not my area of expertise and can not explain the results.

Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology