Audiometric accuracy of the click ABR in infants at risk for hearing loss.

The auditory brainstem response (ABR) to clicks is widely used for early detection of hearing loss in the child at risk for hearing dysfunction, but there is a lack of direct, large-sample estimates of test accuracy. In this report, results and preliminary analyses are presented that relate click ABR thresholds obtained at 3 to 12 months corrected age to detailed follow-up behavioral puretone audiometry at 3 to 8 years of age, for 1,367 ears in 713 children at risk for hearing loss. The data are analyzed in terms of conventional 2 x 2 decision matrices and associated parameters, using dichotomous (binary) measures of hearing loss and ABR test outcome. The accuracy of the ABR appears to depend strongly on the precise criteria that are chosen to define both hearing loss and ABR outcome. ABR accuracy is excellent for detecting average sensorineural hearing loss at 2 and 4 kHz in excess of 30 dB, and the overall results for a wide range of hearing loss and ABR abnormality criteria can be conveniently summarized in terms of relative operating characteristics (ROCs).