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Background: Brainstem Evoked Response Audiometry (BERA) is a crucial diagnostic resource within paediatric audiology. A successful BERA requires sufficient time in order to conduct meaurements using broadband as well as frequency-specific stimuli. Clear measurement requires optimally calm sleep. Melatonin is used in this context (Mel-BERA). We conducted an audit of the clinical BERAs performed within our department during January-March 2025 in order to assess and improve the quality of this essential work. This retrospective study analyses the correlation between melatonin and age, and between melatonin and duration of measurement.

Materials and methods: The data concerning the measurement conditions (e.g. sedative technique and dose, durations of appointment and measurements) and thresholds established for the 68 BERAs attempted within our clinic during January-March 2025 were collated. The median patient age was 1.43 years (SD: 4.1; min. 0.27; max. 17.7). The data analysis was conducted utilising the Python programming language (Spyder version: 5.5.1 (conda), Python version: 3.12.4 64-bit). Regression analysis was performed to analyse the data.

Results: Melatonin-induced sleep conditions (Mel-BERA) were utilised for 56 patients (82%), and sedation/general anaesthetic (Sed/ITN-BERA) by an anaesthetist for 12 (18%). The mean duration of Mel-BERA appointments was 130 mins (sd: 41) with 66 mins (sd: 43) of testing (Sed-BERAs: 94 mins duration (sd: 28)/52 mins testing (sd: 30)). The mean dose of melatonin utilised in this study was 19.0 mg (SD: 8.13), calculated based on an approximate body-weight of 2 mg per kilogram. The investigation revealed no correlation between the melatonin dosage administered and the duration of the measurement, nor between the threshold levels determined and the duration. The regression analysis revealed a strong positive correlation between age and melatonin dosage, with a correlation coefficient of 0.73 (N=41). Conversely, the relationship between measurement duration and melatonin dosage exhibited a weak negative correlation, with a coefficient of -0.31 (N=41).

Conclusions: BERA testing takes a significant amount of time and effort with rather high variability in the conditions required. Overall, these findings suggest that older individuals tend to receive higher melatonin dosages, while the duration of measurements is not strongly related to the dosage administered. Approximately half of the appointment time when using melatonin-induced sleep involves preparations to ensure that a high-quality test can take place.