Cortical Evoked Response Audiometry (CERA) is a form of hearing test that uses sound stimulation responses to objectively assess hearing thresholds. As opposed to a pure tone audiogram, which relies on an individual responding to sounds played through a headset, CERA is an objective test that measures the electrical activity in the auditory cortex of the brain and therefore does not rely on the individual responding.
In a medicolegal context, the vast majority of medical reports will rely on pure tone audiometry to assess an individual’s hearing and to quantify the extent (if any) of noise-induced hearing loss (NIHL). The difficulty with pure tone audiometry is that this form of testing relies on the individual responding to sounds introduced to the ear through a headset. While this can be a reliable form of testing, there remains the possibility that an individual can attempt to exaggerate the extent of their hearing loss by responding to the sounds in a false manner. It is sometimes possible to determine whether an individual is attempting to exaggerate their hearing loss as it can result in an unusual pattern on the audiogram, but this is not always obvious.
In cases where there are doubts as to the accuracy of an individual’s audiogram, it is often beneficial to obtain CERA testing as this method will provide an objective overview of the individual’s true hearing thresholds.
A CERA test is often performed alongside a pure tone audiogram; however, the key benefit to CERA is that the test relies on the brain’s responses to sound stimuli. This means that an individual’s response to sound will be accurately recorded. These results can then be compared with the pure tone audiogram, which should be similar in nature if an individual has responded accurately to the test. If there is a significant difference between the CERA and pure tone audiogram results, this can be a key indicator of an unreliable individual and could raise potential fraud concerns. Further investigation will be required in this instance.
CERA testing was previously a costly option, but with an increase in the number of providers offering such testing, the cost of the same has become more competitive. It is now possible to arrange CERA testing for around £500.
CERA testing is particularly useful for cases in which you have concerns about the reliability of the pure tone audiogram, and especially if you have concerns about the reliability of an individual’s responses during testing. The CERA test provides a clear and objective view of an individual’s hearing. This type of testing can be a useful and economic route to investigate causation in more detail before considering the options of obtaining a full medical report.
CERA testing is not commonly requested, as it largely depends on the circumstances of the case as to whether such a test would prove beneficial. Claimant solicitors can therefore be opposed to obtaining CERA testing, as they can be with basic repeat audiometry.
One of the key benefits of obtaining CERA testing in NIHL claims is that the results do not rely on an individual responding to sound stimuli. Therefore, in cases where there are doubts as to the claimant’s credibility and reliability during testing, a CERA test should iron out those concerns.
It is important to set out the reasons for seeking a CERA test to the claimant’s solicitor: such as concerns with the current audiometry (if there is more than one audiogram available and they show vastly different results), if the audiologist has provided written comments on the audiogram about the claimant’s reliability, if an expert/consultant has commented on the subjective lack of hearing loss symptoms despite an audiogram showing significant hearing loss, etc. It may also be useful to raise Part 35 Questions to the claimant’s medical expert, setting out the concerns with the current audiometry and obtaining their view as to whether CERA testing would be beneficial. If the position as to why CERA testing is being sought has been set out clearly from the outset, this should place you in a better position to seek permission from the court to obtain such testing. The courts are more likely to look favourably on such a request where the position has been clearly set out and there are good reasons for the same. This avenue is also more economic than obtaining a full medical report, and CERA testing can likely be obtained in a shorter timeframe, which is something the courts would look favourably on in fast-track claims.
If you have a claim where you think CERA testing would be of benefit and would like to discuss this, or if you would like to discuss the interpretation of audiometry generally and how we could assist you in managing these types of claims, then please do not hesitate to make contact. We will be happy to discuss matters with you further and assist.
Megan Ainsworth – Solicitor
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