METHODS OF TESTING Your child’s quality of life and development vitally depend on hearing. Hearing helps your child learn to read, to appreciate music and to receive warnings of approaching harm. Your child will have difficulty coping with many of life’s challenges and opportunities without good hearing. Many modern methods can accurately determine the hearing of a newborn, infant or child. A comprehensive hearing assessment can be completed at any age if there is any suspicion that a hearing problem exists. A case history and otoscopic examination are essential. An audiologic evaluation can help determine if a hearing loss exists in one or both ears at frequencies (pitches) that are critical to normal speech and language development, and if any hearing loss is conductive or sensorineural. Below are some of the audiological procedures that may be included in the evaluation process:
- Conventional Audiometry—The audiologist presents tones at different pitches and loudness levels and the child’s responses are observed and recorded. Speech stimuli are also used and responses are observed and recorded.
- Behavioral Observational Audiometry (BOA)—The audiologist observes changes in behavior, such as sucking pattern, widening eyes, or searching for sound in response to various stimuli.
- Visual Reinforcement Audiometry (VRA)—The audiologist uses behavioral conditioning to train your child to respond to sounds presented through a speaker system. Reinforcement is provided immediately by activating a toy that lights up and moves.
- Play Audiometry — The audiologist teaches your child to respond with some action, such as holding a block to the ear and placing it in a bucket whenever a sound is heard.
- Tympanometry — This test measures the movement of the eardrum and the ability of the middle ear to conduct sound to the inner ear.
- Acoustic Reflexes—In a normal ear, the stapedius muscle in the middle ear contracts in response to loud noises at about 70-100 dB (decibels).
- Otoacoustic Emissions (OAE)—A probe in the ear canal measures echoes from the inner ear in response to sound. A normal cochlea creates its own sound in response to sound coming into the ear. If no response is observed, a hearing loss may be present.
- Auditory Brainstem Response (ABR)—Electrodes are placed on your child’s head to pick up the brain’s responses to sound directly. No voluntary response is necessary, so it is often used with infants and very young children. It can even be done while the child is asleep. Audiological management is crucial for children who have a history of otitis media and accompanying hearing loss. A multi-disciplinary approach, which may include the primary care provider, pediatrician, ENT physician and speech-language pathologist, should be used. These children should receive periodic hearing evaluations by a licensed audiologist even when they appear to be symptom-free. In particular, hearing assessment should be completed at the onset of the school year for preschool and elementary students, and at least once during the winter months.