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How does brainstem-evoked response audiometry measure hearing in infants?

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Brainstem-evoked response audiometry (BERA), also known as the auditory brainstem response, is a noninvasive and painless procedure used to estimate hearing sensitivity in infants who cannot participate in standard behavioral testing. Because the test can be performed while the infant is sleeping, it is the preferred method for pediatric assessment.12

During the procedure, electrodes are attached to the infant's scalp, including one placed behind the ear, to record neural activity. The infant is exposed to a series of brief sound stimuli, which evoke minute electrical potentials along the auditory pathway. These signals are amplified and processed by a computer to average the responses and filter out background noise, such as muscle activity.12

The resulting recording typically displays a series of five or six waves that represent the neural responses from successive centers in the brainstem. By starting at a high intensity and gradually reducing the sound level until the evoked response is no longer detectable, clinicians can estimate the infant's hearing threshold based on the presence of these waveforms.21