National Acoustic Laboratories Library

Clinicians' guide to obtaining a valid auditory brainstem response to determine hearing status: signal, noise and cross-checks

By: Norrix, LindaContributor(s): David VelenovskyMaterial type: TextTextOnline resources: Click here to access online In: American Journal of Audiology (January 2018)
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Purpose: The auditory brainstem response (ABR) is a
powerful tool for making clinical decisions about the presence,
degree, and type of hearing loss in individuals in whom
behavioral hearing thresholds cannot be obtained or are
not reliable. Although the test is objective, interpretation of
the results is subjective.
Method: This review provides information about evidencebased
criteria, suggested by the 2013 Newborn Hearing
Screening Program guidelines, and the use of cross-check
methods for making valid interpretations about hearing
status from ABR recordings.
Results: The use of an appropriate display scale setting,
templates of expected response properties, and objective
criteria to estimate the residual noise, signal level, and
signal-to-noise ratio will provide quality data for determining
ABR thresholds. Cross-checks (e.g., immittance measures,
otoacoustic emissions testing, functional indications of
a child’s hearing) are also needed to accurately interpret
the ABR.
Conclusions: Using evidence-based ABR signal detection
criteria and considering the results within the context
of other physiologic tests and assessments of hearing
function will improve the clinician’s accuracy for detecting
hearing loss and, when present, the degree of hearing
loss. Diagnostic accuracy will ensure that appropriate
remediation is initiated and that children or infants
with normal hearing are not subjected to unnecessary

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