Patient guide · Audiology · 6 min read
Auditory brainstem response test, an objective test of hearing and VIII cranial nerve integrity.
The auditory brainstem response (ABR) is a non-invasive electrophysiological test measuring the brainstem’s response to sound. Used in newborn hearing screening, unexplained hearing loss and to screen for vestibular schwannoma.
Key facts
- 01
Definition
A surface-electrode recording of the brainstem’s response to sound along the auditory pathway.
- 02
Non-invasive and objective
Painless, no active participation needed — the response is recorded automatically.
- 03
Waves I–VII
Generated in sequence by the cochlea, auditory nerve and brainstem nuclei.
- 04
Wave V latency
The most robust marker of hearing threshold and neural integrity.
- 05
Newborn hearing screening
The backbone test of the NHS Newborn Hearing Screening Programme.
- 06
Complements MRI
A screening step for retrocochlear pathology, alongside MRI of the internal auditory meatus.
How it’s done
From preparation to report — what happens, in order.
A quiet, painless recording using surface electrodes and insert earphones. In children, done during natural sleep.
- 01
Before
Consultation and history
Symptoms, prior audiology, medications and any relevant obstetric or paediatric history.
- 02
On the day
Skin prepared with electrolyte gel
A gentle scrub with conductive gel to optimise electrode contact and signal quality.
- 03
On the day
Surface electrodes on forehead / mastoids
Small self-adhesive electrodes are placed — no needles, no discomfort.
- 04
On the day
Click or tone-burst stimuli delivered
Calibrated stimuli are presented through insert earphones at set intensities.
- 05
On the day
Recording in a quiet room
You lie still and relaxed while thousands of responses are averaged.
- 06
On the day
Sedation for infants if required
Older infants and young children may need natural sleep or light sedation to stay still.
- 07
After
Audiologist reporting within days
Waveforms are analysed and a written report is issued to your clinician.
Total time in the clinic: around 45–60 minutes for a diagnostic ABR.
What it shows
The patterns the ABR reveals.
Read alongside audiometry and — where indicated — MRI, the ABR points to where along the auditory pathway pathology sits.
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Threshold estimation
Objective estimation of hearing threshold when behavioural audiometry is unreliable.
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Wave V latency
The single most reproducible marker of auditory pathway timing.
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Interpeak intervals (I–III, III–V, I–V)
Segmental timing that localises where along the pathway a delay sits.
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Retrocochlear pathology
Asymmetric latency between the ears is a classical retrocochlear signal.
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Auditory neuropathy spectrum disorder
Present otoacoustic emissions with an absent or grossly abnormal ABR — the diagnostic hallmark.
-
Cortical vs peripheral pathology
Combined with cortical ABR to separate brainstem from higher-order processing lesions.
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Newborn hearing pass / refer
A pass / refer outcome under the NHS Newborn Hearing Screening Programme.
-
Red flag: unilateral asymmetric ABR + SNHL — MRI IAM to exclude vestibular schwannoma
This combination demands cross-sectional imaging of the internal auditory meatus.
Next steps
What follows the result.
The next step depends on the pattern — reassurance, repeat, MRI, referral, amplification or implantation. Here’s the map.
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Reassurance if normal
A normal ABR alongside normal audiometry usually needs no further action.
-
Repeat screen if borderline
Borderline newborn or paediatric results are re-tested before escalation.
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MRI internal auditory meatus
The definitive next test where asymmetric ABR raises retrocochlear suspicion.
-
Hearing aid trial
For confirmed sensorineural loss of a degree that affects communication.
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Cochlear implant assessment
For severe or profound loss where amplification is insufficient.
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ENT / neuro-otology referral
For asymmetric loss, retrocochlear signals or complex neuro-otological cases.
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Speech and language therapy for children
Early intervention to preserve language acquisition once hearing loss is confirmed.
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Follow-up audiology
Serial testing to track progression, response to intervention or post-operative recovery.
Red flags
When the result changes what happens next.
Certain patterns and clinical pictures demand escalation — usually MRI IAM, ENT review, or both. These are the ones we don’t sit on.
-
Vestibular schwannoma
A benign VIIIth nerve tumour flagged by asymmetric ABR latency and SNHL.
-
Auditory neuropathy
Present cochlear function with an absent or grossly abnormal ABR — a distinct diagnostic entity.
-
Sudden SNHL
An ENT emergency — assessment within 24–48 hours to preserve hearing.
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Progressive asymmetric SNHL
Mandatory MRI IAM to exclude a retrocochlear cause regardless of ABR result.
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Retrocochlear lesion
Any structural lesion along the VIIIth nerve or brainstem auditory pathway.
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Post-meningitis hearing loss
Urgent audiological review — cochlear ossification can foreclose implantation options.
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Post-ototoxic drug hearing loss
Aminoglycoside or platinum-based chemotherapy exposure warrants baseline and serial ABR.
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Genetic hearing loss
Family history or syndromic features prompt paediatric audiology and genetics input.
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Delayed speech in children
Objective ABR is the reference standard when behavioural audiometry is unreliable.
Sources
The guidelines that shape this guide.
Reviewed by Pulse Atlas Editorial Board (). Published 2026-07-30. Next review 2027-07-30.
A quiet reminder
This is a patient guide — not a substitute for clinical advice.
If your symptoms are new, sudden or worsening, speak to your audiologist or GP.
- 01 Reference
British Society of Audiology. Recommended procedures — auditory brainstem response testing.
British Society of Audiology. Recommended procedures — auditory brainstem response testing. - 02 Reference
NHS Newborn Hearing Screening Programme. Standards and guidance.
NHS Newborn Hearing Screening Programme. Standards and guidance. - 03 Reference
American Speech-Language-Hearing Association. Auditory evoked potentials.
American Speech-Language-Hearing Association. Auditory evoked potentials. - 04 Reference
Joint Committee on Infant Hearing. Year 2019 position statement.
Joint Committee on Infant Hearing. Year 2019 position statement.
Frequently asked
Everything we get asked about the auditory brainstem response test.
Quick answers on what it feels like, how long it takes, how it fits with other audiology tests, and when MRI is the next step.
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What is an auditory brainstem response test?
A non-invasive electrophysiological test that records the brainstem’s response to sound using surface electrodes placed on the forehead and mastoids. It measures the timing and integrity of the auditory pathway from the cochlea through the brainstem.
-
Is it painful?
No. Small self-adhesive electrodes are placed on the skin after a gentle scrub with conductive gel. Calibrated sounds are delivered through insert earphones — you lie still, and the recording is entirely painless.
-
How long does it take?
Around 45 to 60 minutes in adults. In infants and young children the appointment is longer, because the recording is done during natural sleep or, occasionally, under light sedation.
-
Why is it used in newborn screening?
Because it is objective, needs no behavioural response, and reliably detects the sensorineural and neural hearing losses that most affect early language development. It underpins the NHS Newborn Hearing Screening Programme.
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When is MRI needed after an ABR?
Where the ABR is asymmetric between the ears — particularly with unilateral sensorineural loss — MRI of the internal auditory meatus is the next step to exclude a retrocochlear cause such as a vestibular schwannoma.
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What does an abnormal wave V mean?
A prolonged, absent or asymmetric wave V is the most robust ABR abnormality. It points to a lesion along the auditory pathway and, in the right context, triggers onward MRI and ENT referral.
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In practice, in London
Where auditory brainstem response test sits in a private London pathway
With auditory brainstem response test, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for auditory brainstem response test vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
In practice, a private auditory brainstem response test appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For auditory brainstem response test specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Honesty about expectations is part of the job. A private auditory brainstem response test appointment in London won’t change the underlying medicine — the guidelines, the consultants, and the equipment are largely the same as on the NHS. What it changes is speed, continuity, and the amount of time you get to actually talk through the findings. Everyone we route to is GMC-registered and works within CQC-regulated facilities.
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