Auditory brainstem response threshold estimation: subjective threshold estimation by experienced clinicians in a computer simulation of the clinical test.

Little research has been undertaken into the extent to which auditory brainstem response (ABR) threshold estimation varies between experienced professionals. In this paper, results are presented for 16 professionals who estimated ABR threshold for 12 sets of data in a computer simulation of the clinical test. The design differs from previous research in this area in that subjects had control over the creation of the set of traces from which they would estimate threshold, much as they would in the clinical situation. No agreement for threshold was found for any of the 12 sets of test data across the 16 subjects, and for nine of the sets, the difference between highest and lowest estimated threshold was 40 dB or greater. The maximum difference between highest and lowest estimated threshold was 60 dB. It is argued that the variability is not accounted for by experimental design. The implications for clinical practice are discussed.