BERA – Brainstem Auditory Evoked Responses
Dr. K. K. Desarda
Professor and Head, Otolaryngology.

Dr. A. N. Sangekar
Audiologist and Speech Pathologist,
KEM Hospital, Pune 411 011, Maharashtra, India.

BERA (BSER OR BAEP) has proved to be a useful tool in diagnosing hearing impairments in children which could be conductive or sensorineural in nature. Thanks to early detection, rehabilitative procedures could be started early which will help speech and language development.

We have studied 150 cases below five years of age, and our observations are recorded with case history profiles like high risks, referral for adaptions, congenital malformations and delayed speech. We feel BERA is the only tool which can present an accurate picture of hearing sensitivity.

Introduction
Hearing problems are common among the children which could be conductive or sensorineural in nature. Early diagnosis of hearing impairment is important as the rehabilitative procedure can be started early which will help speech and language development.

Various audiological test procedures are used to assess the hearing sensitivity of children. Some of the common ones are: Behavioral Observation.

• Free Field Audiometry.
• Peep Show.
• Pediatric Tester.

All the above techniques are useful in estimating hearing sensitivity but have their own limitations. The major difficulties involved in the use of these techniques are:

• Co–operation of children.
• Consistency of responses.
• Subjectivity on the part of the tester.
• Assessment of children with multiple handicaps.

BERA, (BSER or BAEP) has proved to be a useful objective tool in diagnosing hearing impairments in children. The use of Auditory Brainstem Response (ABR) (1) audiometry as an audiological tool focused on two principal areas:

• The assessment of hearing sensitivity and slope of loss, (if any) in patients, who are unable or unwilling to participate in standard psychoacoustic test procedures.
• To study the neurological integrity of acoustic nerve and brainstem pathway.

To achieve this objective, the paradigm employed is to collect appropriate ABR data for a case, analyze it and compare the data with relevant norms and draw inferences.

Material and Methods
In this study, an attempt is made to study the findings of BERA in children below the age of five years. These children reported to us or were referred to us for the following reasons:

• Delay in speech and language development.
• Inconsistent responses to sound or inability to respond to sound.
• History of high risk factors – Deafness in the family, consanguineous marriage, difficult/obstructed labor, pre–term/premature labor, administration of antibiotic drugs during pregnancy, diseases contracted by the mother such as Rubella, Meningitis or Hyperbilirubinemia.
• To rule out hearing impairment before adoption.
• To rule out the extent of malformation anomalies especially in Atresia.