Normative aspects of the pediatric auditory brainstem response

The success of any test procedure that involves decision analysis must be based on sound principles, reasonably obtainable data, and a knowledge of response variability. The use of brainstem electric response audiometry (BERA) has gained a prominent role in the clinical assessment of auditory, otoneurologic, and neurologic deficits. However, the road to clinical utility has not been without obstacles. The brainstem response has been besieged with numerous variables which have curtailed universal acceptance and contributed to a lack of established standards. Before BERA is used with any degree of confidence, response variability must be defined and controlled. The purpose of this paper is to review those technical, physiologic, and pathologic conditions which affect response measurement.