Gentle Hearing Care for Children

The auditory brainstem response (ABR) evaluation is commonly utilized for newborns, infants, and children who are unable to respond to behavioral hearing test measures. The ABR tells us how the ear and the nerve pathways from the ear to the brain respond to sound. During this test, it is important for your baby to be very quiet, or preferably, asleep. To complete this test, a pediatric audiologist will clean the skin on your baby’s forehead and behind his or her ears, and then place small electrodes (like a small band aid) at those locations. These electrodes will allow your audiologist to monitor your baby’s response to different sounds that will be played over earphones while they sleep. The audiologist will analyze the responses to determine whether the ears are detecting the sounds. An ABR evaluation is not a painful test, but may take between 30-90 minutes to complete, depending on the needs for the evaluation. After the ABR test is completed, your audiologist will discuss the results, answer questions, and provide recommendations based on test results.

The otoacoustic emissions test evaluates the function of the the cochlea, the organ of hearing, in the inner ear. When sound is presented to the ear, the hair cells within the cochlea vibrate. This vibration produces a low-level emission, or reflection of sound, which is known as an otoacoustic emission (OAE). OAEs are present when hearing is normal or near normal (up to no greater than 35 dB HL of hearing loss). To complete the OAE test, your audiologist will deliver sounds to your child’s ear canal via a small, soft earphone. The resulting response from the ear will be measured and utilized as part of your child’s comprehensive hearing evaluation. After the OAE test is complete, the audiologist will discuss the results and answer any questions you might have.

Tympanometry is used to evaluate the function of the middle ear and ear drum. To complete this test, your audiologist will place a small, soft ear tip in your child’s ear and test how the middle ear system responds to a change in air pressure. Tympanometry is quick, painless, and an essential part of our test battery.

An acoustic reflex is the contraction of a small middle ear muscle in response to louder sounds. This measure is utilized to evaluate middle ear, inner ear, and hearing nerve function. To perform this test, your audiologist will place a soft tip in your child’s ear and present louder tones. Upon presentation of the tones, the stiffness of the eardrum will be measured to determine if an acoustic reflex was elicited.

A behavioral evaluation tests your child’s ability to hear certain speech and tonal sounds. The method by which an audiologist obtains this information varies depending on your child’s age and developmental abilities. For those that are older, conventional measures may be utilized, requiring patient to respond by spoken response or raising their hand in response. However, many children have not developed the skills to respond in such a manner. In those cases, visual reinforcement audiometry or conditioned play audiometry would be utilized to capture this information. These methods are explained below.

For children between 6 months to approximately 2.5 years developmental age, visual reinforcement audiometry (VRA) is utilized to determine awareness to speech and frequency specific sounds. During VRA testing, your child is typically seated on your lap or in a highchair while listening to sounds under earphones or through speakers. For this task, the audiologist will train your child to “look” for sounds upon presentation. When your child turns their head in response to sound, your child’s audiologist will turn on an animated toy that lights up and dances. This reinforcement allows the audiologist to capture your child’s attention and gain important information about their hearing abilities. When needed, team-testing is available to encourage cooperation throughout the VRA test.

From around 2.5 years of age until school age, children often respond best to hearing assessments using a method called Conditioned Play Audiometry (CPA). During this test, your child will listen to sounds presented through earphones and will be trained to play a game in response to each sound. For example, they may drop a toy in a bucket every time they hear a beep. When needed, team testing is available to encourage cooperation throughout the CPA test.

For older children, conventional audiometry is used to determine hearing thresholds. During this test, your child will listen to sounds through earphones and will be asked to raise their hand or press a button when they detect a sound, even at minimal levels. They will also be asked to repeat words to assess word recognition ability and clarity.