Auditory brainstem response (ABR) test (auditory brainstem response testing)
A usually not painful test that records the electrical signals travelling from the ear along the hearing nerve to the brainstem, used to check hearing thresholds and the hearing pathway.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An ABR test records the electrical signals from the ear along the hearing nerve to the brainstem.
- It is usually not painful, needs no response, and is the main way to estimate hearing in babies (done during sleep).
- It is used to estimate hearing levels and to help check the hearing nerve and pathway.
- It does not directly image the brain; an MRI is the main test if a nerve tumour is suspected.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Usually not painful and non-invasive, with no needles into the body and nothing to react to
It is not the main test for imaging the brain or hearing nerve — that is an MRI scan.
You lie still and relaxed (or sleep) while sounds are played and the sensors record. It lasts about 60–90 minutes.
Clear explanation of what the result does and does not show
You lie still and relaxed (or sleep) while sounds are played and the sensors record. It lasts about 60–90 minutes.
The sensors are removed; there may be slight stickiness on the skin. You can carry on as normal.
An audiologist interprets the traces, sometimes at the appointment and sometimes in a report sent afterwards.
Depending on the result, you may be offered other hearing tests, a repeat, or an MRI scan if the hearing nerve...
What is an auditory brainstem response (ABR) test?
An auditory brainstem response (ABR) test looks at how sound travels along the hearing pathway — from the ear, up the hearing nerve, to the lower part of the brain (the brainstem). Small sticker sensors (electrodes) on the head and behind the ears pick up the tiny electrical signals the nerve and brainstem produce when sounds are played.
You simply lie still and relaxed while clicking sounds or tones are played through soft earphones. You do not need to react or press anything — the sensors record the response for you. In babies, who cannot do a standard hearing test, it is the main way to estimate hearing levels, and is done while the baby sleeps naturally.
The test has two main uses. It can estimate how well you hear when an ordinary hearing test is not possible or not reliable. It can also help check the hearing nerve and pathway — for example if there is one-sided hearing loss or tinnitus and a doctor wants to look for a problem on the nerve.
It is usually not painful and non-invasive. It does not directly look at brain structures — if a tumour such as an acoustic neuroma is suspected, an MRI scan is the main test, with ABR sometimes used alongside.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
ABR compared with related tests
| Test | Mainly checks | Needs a response |
|---|---|---|
| ABR | Hearing thresholds and the nerve pathway | No |
| Standard hearing test | Exact hearing levels | Yes |
| OAE test | The cochlea (inner ear) | No |
| MRI scan | Brain and nerve structures | No |
If a nerve tumour is suspected, an MRI is the main investigation; ABR may be used alongside.
Preparing for your test
- For adults, wash your hair beforehand and avoid heavy hair products, so the sensors stick well.
- Plan to relax and keep still during the test; tension and movement can interfere with the recording.
- Tell the clinician about any ear wax, ear infection or recent cold with blocked ears.
- Allow about 60–90 minutes for the appointment.
- For babies, the test is done during natural sleep, so feeding and settling routines matter — follow the clinic's advice.
- Ask whether you will get the result on the day or in a report afterwards.
What happens
The skin behind your ears and on your forehead or scalp is cleaned, and small sticker sensors (electrodes) are placed on it. Soft earphones or inserts are put in or over your ears.
You lie comfortably on a couch and relax — many adults doze. Clicking sounds or tones are played, and the sensors record the electrical responses from the hearing nerve and brainstem. You do not respond to the sounds; the recording does the work, and it is important to stay still and quiet.
The test usually takes about 60–90 minutes. For babies, it is carried out while they sleep naturally, often after a feed. Afterwards the sensors are removed and the audiologist interprets the traces.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- It is not the main test for imaging the brain or hearing nerve — that is an MRI scan.
- It estimates rather than precisely measures hearing, so it is not a substitute for an audiogram where a reliable one can be done.
- Results are affected by wax, middle-ear fluid, movement and muscle tension, which should be minimised.
- On its own it cannot diagnose the cause of dizziness.
Delay or rearrange if…
- Your ears are blocked with wax — clearing it can improve reliability.
- You have an active ear infection or discharge.
- You have had sudden hearing loss — that needs urgent medical assessment first.
- You are unable to stay still or relaxed enough on the day (arrangements may differ for young children).
Alternatives to discuss
- Standard hearing test (pure-tone audiogram) where a reliable one is possible
- OAE test to check the cochlea
- MRI scan to image the hearing nerve and brain
- Auditory steady-state response (ASSR) as a related objective test
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Usually not painful and non-invasive, with no needles into the body and nothing to react to
- Can estimate hearing when a standard hearing test is not possible (especially in babies)
- Gives objective information rather than relying on the person pressing a button
- Helps check the hearing nerve and pathway, for example in one-sided symptoms
- Can guide further tests, such as whether an MRI is needed
Risks & complications
- Mild skin redness or stickiness where the sensors were placed
- Tiredness or restlessness from lying still for up to an hour or more
- The test taking longer or needing repeating if you cannot stay relaxed
- A recording too affected by movement or noise to interpret on the day
- Wax or middle-ear fluid affecting the result
- Anxiety while waiting for results, particularly when the nerve is being checked
- Mild skin irritation from the electrode stickers or cleaning
The ABR test is very safe and usually not painful. Its limits matter more than its risks: it estimates hearing rather than giving an exact audiogram, and it supports but does not replace MRI when a nerve tumour is suspected. Ask how the result will be used and whether any further test, such as a scan, is planned.
Published figures to discuss
The ABR test is non-invasive and carries essentially no physical risk, so complication rates are not meaningful. What matters is interpretation: ABR estimates hearing thresholds and assesses the pathway, but it is influenced by wax, middle-ear problems, movement and the equipment used. As a screen for nerve tumours it can miss small lesions, which is why MRI is the main investigation when these are suspected. Reliable universal accuracy figures vary by indication and equipment and are not quoted here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from ABR | Very low | Surface electrodes and clicking sounds are used; the test is non-invasive. | Guide sourcesClinical context |
| Inconclusive result | Recognised | Movement, poor sleep in children, electrical noise or ear problems can make recordings hard to interpret. | Guide sourcesClinical context |
| False reassurance if used alone | Core limitation | ABR assesses part of the hearing pathway and should be combined with audiology, examination and sometimes MRI. | Guide sourcesClinical context |
| Sedation risk in some children | Only if sedation or anaesthesia is needed | Many ABRs are natural-sleep tests, but planned sedation needs separate consent and monitoring. | Auditory Brainstem Response — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no recovery needed. The sensors are peeled off at the end and you can return to normal activities immediately.
- Slight redness or stickiness where the sensors were
- Feeling a little tired after lying still for a while
- Results that are interpreted with your other tests and history
- Possible onward referral for an MRI or further hearing assessment
Aftercare
- No specific aftercare is needed; wash off any sensor residue at home.
- Attend any further tests or scans that are recommended.
- Ask what the result means for your hearing or symptoms and what happens next.
- Report any new ear pain, discharge or sudden change in hearing.
- For babies, follow the audiology team's advice about results and any follow-up.
- Hair washed and product-free (adults)
- Comfortable clothing for lying still
- Details of ear symptoms, wax or recent infections to mention
- Previous hearing tests or scan results to bring
- For babies, feeding/sleep routine planned per clinic advice
- Questions about results and next steps written down
⚠ Get urgent help if…
- Sudden hearing loss in one or both ears — seek same-day medical advice
- New one-sided tinnitus, or tinnitus that pulses with your heartbeat
- Dizziness, unsteadiness, facial weakness or numbness
- New ear pain, discharge or bleeding from the ear
- Rapidly worsening hearing in one ear
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
In threshold testing, the ABR estimates the quietest sounds your ear responds to, which helps build a picture of your hearing — particularly useful in babies. In neurological testing, the timing and pattern of the responses can suggest whether the hearing nerve and brainstem pathway are working normally.
A normal ABR is reassuring but not absolute: it estimates hearing rather than measuring it exactly, and it cannot, by itself, rule out every nerve or brain problem. Where a tumour such as an acoustic neuroma is suspected, an MRI scan is the main test, and a normal ABR does not replace it.
An ABR reflects the hearing pathway at the time of testing. Hearing and nerve function can change, so repeat or further testing may be advised, especially in children being monitored or where symptoms continue. A single result is a snapshot.
Related tests, treatments or support
ABR is often done alongside other hearing tests — a standard hearing test where possible, OAE testing and tympanometry — to map where in the pathway a problem lies. Where the hearing nerve needs imaging, an MRI scan is arranged separately.
Follow-up & long-term care
Follow-up depends on the reason for the test. In babies, results feed into a structured hearing-care pathway with further appointments. In adults, you may be offered other tests, a repeat, or an MRI, with onward referral as needed.
- Attend recommended monitoring appointments, especially for children
- Have hearing rechecked if symptoms change
- Keep ears free of excess wax for reliable future testing
Repeat, follow-on and what comes next
- A repeat may be needed if movement, noise or wax spoiled the recording.
- An abnormal or borderline result often leads to an MRI or further hearing tests rather than a diagnosis on the day.
- Children are frequently retested over time as part of monitoring.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear explanation of what the result does and does not show
- A written report and, where needed, onward MRI or hearing tests
- For children, integration into a structured hearing-care pathway
- Advice on when to seek help (sudden hearing loss, one-sided tinnitus, facial symptoms)
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether it is a threshold (hearing-level) or neurological (pathway) ABR
- The time and expertise needed to carry out and interpret the test
- Whether it is bundled with other hearing tests
- Whether sedation or special arrangements are needed (mainly for young children)
- Whether a follow-up consultation or report is included
- The fee for the test and what is included
- Whether other hearing tests are bundled or charged separately
- Who interprets the result and whether a report is provided
- Whether a follow-up consultation is included
- What happens, and what it costs, if a scan or further testing is needed
- The cancellation policy
On the NHS? ABR testing is widely available on the NHS, including after newborn hearing screening and in ENT and audiology services; private testing is mainly used for quicker access.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting a normal ABR as ruling out a nerve tumour when MRI is the definitive test.
- Treating an estimated threshold as an exact hearing measurement.
- Not explaining that wax, fluid and movement affect the result.
- No clear plan for further imaging or testing if needed.
Marketing red flags
- Claiming an ABR can fully rule out an acoustic neuroma without MRI
- Selling it as a complete hearing or brain assessment on its own
- Quoting a normal result as a guarantee of normal hearing
- Pushing repeat private tests without clear clinical reason
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is this test to estimate my hearing, to check my hearing nerve, or both?
- What will the result tell you, and what will it not tell you?
- Will I also need an MRI scan or other hearing tests?
- How and when will I get the results?
- What is the next step if the result is abnormal or unclear?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does the ABR test hurt?
Why does it take so long?
Will my baby need to be asleep?
Can an ABR rule out a tumour on the hearing nerve?
Is it the same as a standard hearing test?
Is it available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Great Ormond Street Hospital — ABR test (PDF) Auditory Brainstem Response — StatPearls (NCBI) NHS — Newborn hearing screening
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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