ABSTRACT The analysis of the Auditory Brainstem Response (ABR) is of fundamental importance to the investigation of the auditory system behavior, though its interpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analyzing the ABR, clinicians are often interested in the identification of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave latency) is a practical tool for the diagnosis of disorders affecting the auditory system. In this context, the aim of this research is to compare ABR manual/visual analysis provided by different examiners. Methods: The ABR data were collected from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). A total of 160 data samples were analyzed and a pair- wise comparison between four distinct examiners was executed. We carried out a statistical study aiming to identify significant differences between assessments provided by the examiners. For this, we used Linear Regression in conjunction with Bootstrap, as a method for evaluating the relation between the responses given by the examiners. Results: The analysis suggests agreement among examiners however reveals differences between assessments of the variability of the waves. We quantified the magnitude of the obtained wave latency differences and 18% of the investigated waves presented substantial differences (large and moderate) and of these 3.79% were considered not acceptable for the clinical practice. Conclusions: Our results characterize the variability of the manual analysis of ABR data and the necessity of establishing unified standards and protocols for the analysis of these data. These results may also contribute to the
validation and development of automatic systems that are employed in the early diagnosis of hearing loss.
Cite this paper
Naves, K. , Pereira, A. , Nasuto, S. , Russo, I. and Andrade, A. (2012) Analysis of the variability of auditory brainstem response components through linear regression. Journal of Biomedical Science and Engineering, 5, 517-525. doi: 10.4236/jbise.2012.59064.
 Eggermont, J.J. (2007) Electric and magnetic fields of synchronous neural activity. In: Burkard, R.F., Eggermont, J.J. and Don, M., Eds., Auditory evoked potentials: Basic principles and clinical application. Lippincott Williams & Wilkins, Baltimore, 2-21.
Hood, L.J. (1998) Clinical applications of the auditory brainstem response. Singular Publishing Group Inc., San Diego.
Nodarse, E.M., Abalo, M.C.P. and López, G.S. (2006) Métodos de pesquisaje de las pérdidas auditivas a edades tempranas. Revista Electrónica de Audiologia, 3, 9-18.
Hall, J.W. (2006) New handbook of auditory evoked responses. Pearson Edication Inc., Boston.
Misulis, K.E. (2003) Potencial evocado de spehlmann. 2nd Edition, Revinter Ltda, Rio de Janeiro.
 Schwanke, D. (2000) Exame de potenciais evocados auditivos utilizando processador digital de sinais—DSPEA. Dissertacao de Mestrado, Instituto de Informática, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul.
Sininger, Y.S. (2007) Source analysis of auditory evoked potentials and fields. In: Burkard, R.F., Eggermont, J.J. and Don, M., Eds., The use of auditory brainstem response in screening for hearing loss and audiometric threshold prediction. Lippincott Williams & Wilkins, Baltimore, 254-274.
Martin, W.H. and Shi, B.Y.B. (2007) Intraoperative monitoring. In: Burkard, R.F., Eggermont, J.J. and Don, M., Eds., Auditory evoked potentials: Basic principles and clinical application. Lippincott Williams & Wilkins, Philadelphia, 355-384.
Katz, J. (1989) Audiologia clínica. 3rd Edition, Manole, New York.
de Garcia, B.G., Gaffney, C., Chacon, S., et al. (2011) Overview of newborn hearing screening activities in Latin America. Revista Panamericana de Salud Pública, 29, 145-152.
Chomsky, N. (2005) Three factors in language design. Linguistic Inquiry, 36, 1-22. doi:10.1162/0024389052993655
Fitcha, W.T., Hauserb, M.D. and Chomsky, N. (2005) The evolution of the language faculty: Clarifications and implications. Cognition, 97, 179-210.
Junqueira, C.A.O. and Colafêmina, J.F. (2002) Investigacao da estabilidade inter e intra-examinador na identifycacao do P300 auditivo: Análise de erros. Revista Brasileira de Otorrinolaringologia, 68, 468-478.
Pediatrics, A.A.O. (1999) Newborn and infant hearing loss: Detection and Intervention. Pediatricis, 103, 527-530. doi:10.1542/peds.103.2.527
Vidler, M. and Parker, D. (2004) Auditory brainstem response threshold estimation: Subjective threshold estimation by experienced clinicians in a computer simulation of the clinical test. International Journal of Audiology, 43, 417-429. doi:10.1080/14992020400050053
B?cker, K.B.E., van Avermaete, J.A.G., and van den Berg- Lenssen, M.M.C. (2005) The international 10-20 system revisited: Cartesian and spherical co-ordinates. Brain Topography, 6, 231-235.
Efron, B. and Tibshirani, R.J. (1998) An introduction to the bootstrap, Chapman & Hall/CRC, Boca Raton.
Johnson, R.W. (2001) An introduction to the bootstrap. Journal of Royal Statistical Society: Series D, 23, 49-54.
Andrade, A.O. (2005) Decomposition and analysis of electromyographic signals. Ph.D Thesis, School of Systems Engineering, Department of Cybernetics, The University of Reading, Reading.
Don, M., Ponton, C.W., Eggermont, J.J., et al. (1998) The effects of sensory hearing loss on cochlear filter times estimated from auditory brainstem response latencies. Acoustical Society of America, 104, 2280-2289. doi:10.1121/1.423741
Hernández, J.D., Castro, F.Z. and Prat, J.J.B. (2003) Normalización de los potenciales evocados auditivos del tronco cerebral I: Resultados en una muestra de adultos normoyentes. Revista Electrónica de Audiologia, 2, 13-18.
de Montes, C., Manjón, M., vinuales, M. et al. (2002) Estúdio morfológico de los potenciales evocados auditivos de tronco del encéfalo. Influência de la posición del eletrodo de referência. Revista de Neurologia, 34, 84-88.
Antonelli, A.R., Bellotto, R. and Grandori, F. (1987) Audiologic diagnosis of central versus eighth nerve and co-chlear auditory impairment. Audiology, 4, 209-226. doi:10.3109/00206098709081550
Vannier, E., Adam, O. and Motsch, J.-F. (2002) Objective detection of brainstem auditory evoked potentials with a priori information from higher presentation levels. Artificial Intelligence in Medicine, 25, pp. 283-301. doi:10.1016/S0933-3657(02)00029-5
Burkard, R.F. and Don, M. (2007) The auditory brain-stem response.In: Burkard, R.F. Don, M. and Eggermont, J.J., Eds., Auditory evoked potencials: Basic principles and clinical applications. Lippincott Williams & Wilkins, Baltimore, 229-253.
Don, M. (1989) Quantitative approaches for defining the quality and threshold of auditory brainstem responses. IEEE Engineering in Medicine & Biology Society, 2, 761-762.
Acyra, N., Ozdamarb, O. and Guzelis, C. (2006) Automatic classification of auditory brainstem responses using SVM-based feature selection algorithm for threshold detection. Engineering Applications of Artificial Intelligence, 19, 209-218.
Boston, J.R. (1989) Automated Interpretation of brain-stem auditory evoked potentials: A prototype system. IEEE Transactions on Biomedical Engineering, 36, 528-532. doi:10.1109/10.24254
Bradley, A.P. and Wilson, W.J. (2004) On wavelet analysis of auditory evoked potentials. Clinical Neurophysiology, 115, 1114-1128. doi:10.1016/j.clinph.2003.11.016
Jacquin, A., Causevic, E., John, E.R., et al. (2006) Optimal denoising of brainstem auditory evoked response (BAER) for Automatic peak identification and brainstem assessment. Proceedings of the 28th IEEE EMBS Annual International Conference, New York, 30 August-3 September 2006, 1723-1726.
Hunt, R.J. (1986) Percent agreement, Pearson’s correlation, and kappa as measures of interexaminer reliability. Journal of Dental Research, 65, 128-130.