The effects of stimulus rate on detectability of the auditory brain stem response in infants.

This study was undertaken to determine the feasibility of using a fast stimulus rate for auditory brain stem response (ABR) hearing screening in infants. Eighty-four neonates and infants with postconceptional ages (PCA) from 30 to 78 weeks with clear ABRs to click rate of 40/sec at 30 dB HL were retested at 90/sec. Ninety-two percent of infants with PCA > 42 weeks had a clearly identifiable ABR at the 90/sec rate. In contrast, 71% of the infants with PCA between 37 and 42 weeks, and only 50% of the infants with PCA < 37 weeks, had clearly identifiable ABRs at 90/sec. Thus, a 90/sec stimulus rate was not practical on infants < 43 weeks PCA. Accordingly, ABR detectability was assessed to 40 dB clicks at 70/sec compared to the 40/sec rate on 20 infants between 33 and 42 weeks PCA. ABRs were detectable on 85% of this group, which suggests that these parameters may be more reasonable, but further data are needed. ABR measures for hearing screening on infants > 42 weeks and children can be satisfactorily performed at stimulus rates up to 90/sec; however, infants who fail the screening when using a fast stimulus rate should have a repeated measurement at a slower rate to rule out a false positive result.