Evaluating Factors Affecting Audiologists’ Diagnostic Performance in Auditory Brainstem Response Reading: Training and Experience
This study aims to determine if audiologists' experience characteristics in ABR (Auditory Brainstem Response) reading is associated with their performance in interpreting ABR results. Fifteen ABR traces with varying degrees of hearing level were presented twice, making a total of 30. Audiologists were asked to determine the hearing threshold for each of the cases after completing a brief survey regarding their experience and training in ABR administration. Sixty-one audiologists completed all tasks. Correlations between audiologists’ performance measures and experience variables suggested significant associations (p < 0.05) between training period in ABR testing and audiologists’ performance in terms of both sensitivity and accuracy. In addition, the number of years conducting ABR testing correlated with specificity. No other correlations approached significance. While there are relatively few significant correlations between ABR performance and experience, accuracy in ABR reading is associated with audiologists’ length of experience and period of training. To improve audiologists’ performance in reading ABR results, an emphasis on the importance of training should be raised and standardized levels and period for audiologists training in ABR testing should also be set.
[1] World Health Organization (WHO), “WHO global estimates on prevalence of hearing loss: Mortality and Burden of Diseases and Prevention of Blindness and Deafness,” 2015.
[2] World Health Organization (WHO), “WHO global estimates on prevalence of hearing loss,” 2012.
[3] C. Yoshinaga-Itano, A. L. Sedey, D. K. Coulter, A. L. Mehl, “Language of Early- and Later-identified Children With Hearing Loss,” Pediatrics, vol. 102, no. 5, pp. 1161-1171, 1998.
[4] World Health Organization (WHO), “Newborn and Infant Hearing screening: Current issues and principles for action,”, 2009.
[5] American Speech-Language-Hearing Association (ASHA), “Audiology Information Series: Effects of Hearing Loss on Development,” 2011.
[6] A. Fulcher, A.A., Purcell, E. Baker, N. Munro, “Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3years-of-age,” International journal of pediatric otorhinolaryngology, vol. 76, no. 12, pp. 1785-1794, 2012.
[7] M. L. Hyde, K. Riko, K. Malizia, “Audiometric accuracy of the click ABR in infants at risk for hearing loss,” Journal of the American Academy of Audiology, vol. 1, no. 2, pp. 59-66, 1990.
[8] C. D. Bauch, W. O. Olsen, “The effect of 2000-4000 Hz hearing sensitivity on ABR result,” Ear and hearing, vol. 7, no. 5, pp. 314-317, 1986.
[9] V. Rawool, S. Zerlin, “Phase-intensity effects on the AB,” Scandinavian audiology, vol. 17, no. 2, pp. 117-123, 1988.
[10] Z. Jiang, Y. Wu, L. Zhang, “Amplitude change with click rate in human brainstem auditory-evoked responses,” International Journal of Audiology, vol. 30, no. 3, pp. 173-182, 1991.
[11] Z. D. Jiang, “Intensity effect on amplitude of auditory brainstem responses in human,” Scandinavian audiology, vol. 20, no. 1, pp. 41-47, 1991.
[12] D. R. Stapells, T. W. Picton, “Technical aspects of brainstem evoked potential audiometry using tones,” Ear and Hearing, vol. 2, no. 1, 1981, pp. 20-29.
[13] D. Gans, D. D. Zotto, K. D. Gans, “Bias in scoring auditory brainstem responses,” British Journal of Audiology, vol. 26, no. 6, pp. 363-368, 1992.
[14] K. F. Naves, A. A. Pereira, S. J. Nasuto, I. P. Russo, A. O. Andrade, “Analysis of the variability of auditory brainstem response components through linear regression,” Journal of Biomedical Science and Engineering, vol. 5, no. 5, pp. 517-525, 2012.
[15] K. F. Naves, A. A. Pereira, S. J. Nasuto, I. P. Russo, A. O. Andrade, “Assessment of inter-examiner agreement and variability in the manual classification of auditory brainstem response,” Biomedical engineering online, vol. 11, no. 1, 2012, p. 86, 2012.
[16] W. O. Olsen, T. L. Pratt, C. D. Bauch, “Consistency in Latency Measurements and Interpretation of ABR Tracings,” American Journal of Audiology, vol. 6, no. 1, p. 57, 1997.
[17] T. L. Pratt, W. O. Olsen, C. D. “Bauch, Four-channel ABR recordings: Consistency in interpretation,” American Journal of Audiology, vol. 4, no. 2, p. 47, 1995.
[18] M. Vidler, D. Parker, “Auditory brainstem response threshold estimation: subjective threshold estimation by experienced clinicians in a computer simulation of the clinical test,” International Journal of Audiology, vol. 43, no. 7, pp. 417-429, 2004.
[19] R. F. Burkard, J. J. Eggermont, M. Don, Auditory evoked potentials: basic principles and clinical application, Lippincott Williams & Wilkins, 2007.
[20] B. Mcpherson, “Newborn hearing screening in developing countries: Needs & new directions,” The Indian journal of medical research, vol. 135, no. 2, p. 152, 2012.
[21] A. A. Dzulkarnain, W. M. Wan Mhd Pandi, W. J. Wilson, A. P. Bradley, F. Sapian, “A preliminary investigation into the use of an auditory brainstem response (ABR) simulator for training audiology students in waveform analysis,” International journal of audiology, vol. 53, no. 8, pp. 514-521, 2014.
[22] K. Boutis, M. Pecaric, B. Seeto, M. Pusic, “Using signal detection theory to model changes in serial learning of radiological image interpretation,” Advances in health sciences education, vol. 15, no. 5, pp. 647-658, 2010.
[23] R. M. Hatala, L. R. Brooks, G. R. “Norman, Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills,” Advances in Health Sciences Education, vol. 8, no. 1, pp. 17-26, 2003.
[24] W. C. Mcgaghie, S. B. Issenberg, E. R. Petrusa, R. J. Scalese, “Effect of practice on standardised learning outcomes in simulation‐based medical education,” Medical education, vol. 40, no. 8, pp. 792-797, 2006.
[25] J. G. Elmore, D. L. Miglioretti, L. M. Reisch, et al. “Screening mammograms by community radiologists: variability in false-positive rates,” Journal of the National Cancer Institute, vol. 94, no. 18, pp. 1373-1380, 2002.
[26] L. Esserman, H. Cowley, C. Eberle, et al. “Improving the accuracy of mammography: volume and outcome relationships,” Journal of the National Cancer Institute, vol. 94, no. 5, pp. 369-375, 2002.
[27] R. Smith-Bindman, P. Chu, D. L. Miglioretti, et al. “Physician predictors of mammographic accuracy,” Journal of the National Cancer Institute, vol. 97, no. 5, pp. 358-367, 2005.
[28] J. S. Gravel, R. Seewald, “Potential pitfalls in the audiological assessment of infants and young children,” Presented at: A sound foundation through early amplification: Conference proceedings from the second international conference, 2001.
[29] Zubizarreta, R. Alberdi, A. B. Llanes, R. A. Ortega, et al. “Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs,” 2011.
[30] J. W. Williams, D. L. Simel, “Does This Patient Have Ascites?: How to Divine Fluid in the Abdomen,” Jama, vol. 267, no. 19, pp. 2645-2648 , 1992.
[31] M. E. Pichichero, M. D. Poole, “Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media,” Archives of pediatrics & adolescent medicine, vol. 155, no. 10, pp. 1137-1142, 2001.
[32] D. L. Elliot, D. H. Hickam, “Evaluation of physical examination skills: Reliability of faculty observers and patient instructors,” JAMA, vol. 258, no. 23, pp. 3405-3408, 1987.
[33] S. Mangione, “Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries,” The American journal of medicine, vol. 110, no. 3, pp. 210-216, 2001.
[34] S. Mangione, L. Z. Nieman, “Cardiac auscultatory skills of internal medicine and family practice trainees: a comparison of diagnostic proficiency,” Jama, vol. 278, no. 9, pp. 717-722, 1997.
[35] S. D. Levitt, J. A. List, “What do laboratory experiments measuring social preferences reveal about the real world?,” The journal of economic perspectives, pp. 153-174, 2007.
[36] J. A. List, S. D. Levitt, “What do laboratory experiments tell us about the real world,” NBER Working Paper 2005.
[1] World Health Organization (WHO), “WHO global estimates on prevalence of hearing loss: Mortality and Burden of Diseases and Prevention of Blindness and Deafness,” 2015.
[2] World Health Organization (WHO), “WHO global estimates on prevalence of hearing loss,” 2012.
[3] C. Yoshinaga-Itano, A. L. Sedey, D. K. Coulter, A. L. Mehl, “Language of Early- and Later-identified Children With Hearing Loss,” Pediatrics, vol. 102, no. 5, pp. 1161-1171, 1998.
[4] World Health Organization (WHO), “Newborn and Infant Hearing screening: Current issues and principles for action,”, 2009.
[5] American Speech-Language-Hearing Association (ASHA), “Audiology Information Series: Effects of Hearing Loss on Development,” 2011.
[6] A. Fulcher, A.A., Purcell, E. Baker, N. Munro, “Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3years-of-age,” International journal of pediatric otorhinolaryngology, vol. 76, no. 12, pp. 1785-1794, 2012.
[7] M. L. Hyde, K. Riko, K. Malizia, “Audiometric accuracy of the click ABR in infants at risk for hearing loss,” Journal of the American Academy of Audiology, vol. 1, no. 2, pp. 59-66, 1990.
[8] C. D. Bauch, W. O. Olsen, “The effect of 2000-4000 Hz hearing sensitivity on ABR result,” Ear and hearing, vol. 7, no. 5, pp. 314-317, 1986.
[9] V. Rawool, S. Zerlin, “Phase-intensity effects on the AB,” Scandinavian audiology, vol. 17, no. 2, pp. 117-123, 1988.
[10] Z. Jiang, Y. Wu, L. Zhang, “Amplitude change with click rate in human brainstem auditory-evoked responses,” International Journal of Audiology, vol. 30, no. 3, pp. 173-182, 1991.
[11] Z. D. Jiang, “Intensity effect on amplitude of auditory brainstem responses in human,” Scandinavian audiology, vol. 20, no. 1, pp. 41-47, 1991.
[12] D. R. Stapells, T. W. Picton, “Technical aspects of brainstem evoked potential audiometry using tones,” Ear and Hearing, vol. 2, no. 1, 1981, pp. 20-29.
[13] D. Gans, D. D. Zotto, K. D. Gans, “Bias in scoring auditory brainstem responses,” British Journal of Audiology, vol. 26, no. 6, pp. 363-368, 1992.
[14] K. F. Naves, A. A. Pereira, S. J. Nasuto, I. P. Russo, A. O. Andrade, “Analysis of the variability of auditory brainstem response components through linear regression,” Journal of Biomedical Science and Engineering, vol. 5, no. 5, pp. 517-525, 2012.
[15] K. F. Naves, A. A. Pereira, S. J. Nasuto, I. P. Russo, A. O. Andrade, “Assessment of inter-examiner agreement and variability in the manual classification of auditory brainstem response,” Biomedical engineering online, vol. 11, no. 1, 2012, p. 86, 2012.
[16] W. O. Olsen, T. L. Pratt, C. D. Bauch, “Consistency in Latency Measurements and Interpretation of ABR Tracings,” American Journal of Audiology, vol. 6, no. 1, p. 57, 1997.
[17] T. L. Pratt, W. O. Olsen, C. D. “Bauch, Four-channel ABR recordings: Consistency in interpretation,” American Journal of Audiology, vol. 4, no. 2, p. 47, 1995.
[18] M. Vidler, D. Parker, “Auditory brainstem response threshold estimation: subjective threshold estimation by experienced clinicians in a computer simulation of the clinical test,” International Journal of Audiology, vol. 43, no. 7, pp. 417-429, 2004.
[19] R. F. Burkard, J. J. Eggermont, M. Don, Auditory evoked potentials: basic principles and clinical application, Lippincott Williams & Wilkins, 2007.
[20] B. Mcpherson, “Newborn hearing screening in developing countries: Needs & new directions,” The Indian journal of medical research, vol. 135, no. 2, p. 152, 2012.
[21] A. A. Dzulkarnain, W. M. Wan Mhd Pandi, W. J. Wilson, A. P. Bradley, F. Sapian, “A preliminary investigation into the use of an auditory brainstem response (ABR) simulator for training audiology students in waveform analysis,” International journal of audiology, vol. 53, no. 8, pp. 514-521, 2014.
[22] K. Boutis, M. Pecaric, B. Seeto, M. Pusic, “Using signal detection theory to model changes in serial learning of radiological image interpretation,” Advances in health sciences education, vol. 15, no. 5, pp. 647-658, 2010.
[23] R. M. Hatala, L. R. Brooks, G. R. “Norman, Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills,” Advances in Health Sciences Education, vol. 8, no. 1, pp. 17-26, 2003.
[24] W. C. Mcgaghie, S. B. Issenberg, E. R. Petrusa, R. J. Scalese, “Effect of practice on standardised learning outcomes in simulation‐based medical education,” Medical education, vol. 40, no. 8, pp. 792-797, 2006.
[25] J. G. Elmore, D. L. Miglioretti, L. M. Reisch, et al. “Screening mammograms by community radiologists: variability in false-positive rates,” Journal of the National Cancer Institute, vol. 94, no. 18, pp. 1373-1380, 2002.
[26] L. Esserman, H. Cowley, C. Eberle, et al. “Improving the accuracy of mammography: volume and outcome relationships,” Journal of the National Cancer Institute, vol. 94, no. 5, pp. 369-375, 2002.
[27] R. Smith-Bindman, P. Chu, D. L. Miglioretti, et al. “Physician predictors of mammographic accuracy,” Journal of the National Cancer Institute, vol. 97, no. 5, pp. 358-367, 2005.
[28] J. S. Gravel, R. Seewald, “Potential pitfalls in the audiological assessment of infants and young children,” Presented at: A sound foundation through early amplification: Conference proceedings from the second international conference, 2001.
[29] Zubizarreta, R. Alberdi, A. B. Llanes, R. A. Ortega, et al. “Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs,” 2011.
[30] J. W. Williams, D. L. Simel, “Does This Patient Have Ascites?: How to Divine Fluid in the Abdomen,” Jama, vol. 267, no. 19, pp. 2645-2648 , 1992.
[31] M. E. Pichichero, M. D. Poole, “Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media,” Archives of pediatrics & adolescent medicine, vol. 155, no. 10, pp. 1137-1142, 2001.
[32] D. L. Elliot, D. H. Hickam, “Evaluation of physical examination skills: Reliability of faculty observers and patient instructors,” JAMA, vol. 258, no. 23, pp. 3405-3408, 1987.
[33] S. Mangione, “Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries,” The American journal of medicine, vol. 110, no. 3, pp. 210-216, 2001.
[34] S. Mangione, L. Z. Nieman, “Cardiac auscultatory skills of internal medicine and family practice trainees: a comparison of diagnostic proficiency,” Jama, vol. 278, no. 9, pp. 717-722, 1997.
[35] S. D. Levitt, J. A. List, “What do laboratory experiments measuring social preferences reveal about the real world?,” The journal of economic perspectives, pp. 153-174, 2007.
[36] J. A. List, S. D. Levitt, “What do laboratory experiments tell us about the real world,” NBER Working Paper 2005.
@article{"International Journal of Medical, Medicine and Health Sciences:78794", author = "M. Zaitoun and S. Cumming and A. Purcell", title = "Evaluating Factors Affecting Audiologists’ Diagnostic Performance in Auditory Brainstem Response Reading: Training and Experience ", abstract = "This study aims to determine if audiologists' experience characteristics in ABR (Auditory Brainstem Response) reading is associated with their performance in interpreting ABR results. Fifteen ABR traces with varying degrees of hearing level were presented twice, making a total of 30. Audiologists were asked to determine the hearing threshold for each of the cases after completing a brief survey regarding their experience and training in ABR administration. Sixty-one audiologists completed all tasks. Correlations between audiologists’ performance measures and experience variables suggested significant associations (p < 0.05) between training period in ABR testing and audiologists’ performance in terms of both sensitivity and accuracy. In addition, the number of years conducting ABR testing correlated with specificity. No other correlations approached significance. While there are relatively few significant correlations between ABR performance and experience, accuracy in ABR reading is associated with audiologists’ length of experience and period of training. To improve audiologists’ performance in reading ABR results, an emphasis on the importance of training should be raised and standardized levels and period for audiologists training in ABR testing should also be set.
", keywords = "ABR, audiology, performance, training, experience.", volume = "13", number = "5", pages = "259-6", }
