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To the Editor: In answer to Dr. Jerger's letter:
Dr. Jerger's comments are well taken, and we agree that the average or median shift in threshold obtained in the SAL test represents a norm subject to the usual variability inherent in any norm. But is it sufficient that the standard for comparison with individual threshold shifts be a norm? We contend that it is not. Most other determinations in audiologic evaluation are based on the average of direct measurements under the same conditions. Furthermore, a range of variability around a central point is taken into consideration in the most commonly used audiologic measurements. On the other hand, cochlear reserve, as measured by the SAL test, is an indirect measurement, determined finally by a mathematical formula. It therefore seems quite logical to assume that the factor in this formula used as the standard for comparison with individual measurements should be a