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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.

Materials and methods: Data concerning success rates of the 68 BERAs attempted within our clinic during Jan-March 2025 were collated. “Success” was defined as being sufficient for diagnostic and management purposes and classified as fully-, partially- or insufficient. Median patient age was 1.43 years (sd: 4.1; min. 0.27; max. 17.7).

Results: No data was obtained for only 5 of the 68 patients (9%) for lack of sleep. Broadband Chirps (rather than Clicks) were used 88% of the time. Bilateral 3-frequency thresholds were obtained for 69% of patients. For 79%, the results were fully sufficient for diagnostic and management purposes; 21% were partially sufficient (74% and 26%, respectively, for Mel-BERAs). Success rates were notably higher for children 36 months old (only 43% fully sufficient, N=14). Some reasons identifed for only partial success include complications regarding sleeping position (binaural measurement and masking limited), unsettled sleep, accidental disturbance of child during testing (stimulation too high, transducer changes disruptive), and parental stress. The role of a clear priority-based test protocol was identified as crucial.

Conclusions: BERA attempts rarely fail completely: sufficient detail for diagnosis and management following recommended technical protocols can be obtained in the vast majority of cases. The probability of BERA being fully successful for diagnostic and management purposes is higher at a younger patient age. Specific situational factors could be identified and taken into account. A priority-based test protocol is essential.