Clinicians' Guide to Obtaining a Valid Auditory Brainstem Response to Determine Hearing Status: Signal, Noise, and Cross-Checks 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. ... Clinical Focus
Clinical Focus  |   March 08, 2018
Clinicians' Guide to Obtaining a Valid Auditory Brainstem Response to Determine Hearing Status: Signal, Noise, and Cross-Checks
 
Author Affiliations & Notes
  • Linda W. Norrix
    Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
  • David Velenovsky
    Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Linda Norrix: norrix@email.arizona.edu
  • Editor-in-Chief: Sumitrajit Dhar
    Editor-in-Chief: Sumitrajit Dhar×
  • Editor: Ann Eddins
    Editor: Ann Eddins×
Article Information
Hearing & Speech Perception / Acoustics / Hearing Disorders / Clinical Focus
Clinical Focus   |   March 08, 2018
Clinicians' Guide to Obtaining a Valid Auditory Brainstem Response to Determine Hearing Status: Signal, Noise, and Cross-Checks
American Journal of Audiology, March 2018, Vol. 27, 25-36. doi:10.1044/2017_AJA-17-0074
History: Received August 9, 2017 , Revised September 25, 2017 , Accepted October 16, 2017
 
American Journal of Audiology, March 2018, Vol. 27, 25-36. doi:10.1044/2017_AJA-17-0074
History: Received August 9, 2017; Revised September 25, 2017; Accepted October 16, 2017

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 evidence-based 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 intervention.

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