Pediatric Hearing Tests

Approximately 1.4 infants per 1000 births are born with hearing loss. Early identification of hearing loss is important, as hearing is a critical part of a child’s social, emotional, and cognitive development.

The Importance of Testing Your Child’s Hearing

Newborns should have a hearing screening before being discharged from the hospital. If your baby did not have this screening, it is important to have your baby’s hearing tested by one month of age. Hearing loss can affect a child’s ability to learn through hearing.

If your child passed the newborn hearing screening, continue to watch for signs that there may be a hearing problem. Signs of hearing loss may include: delayed speech and language development; limited, poor, or no speech; frequent inattentiveness; difficulty learning; failing to respond to conversational level speech or answering inappropriately to speech; and needing TV at a higher volume. If you suspect hearing loss, contact an audiologist to have your child’s hearing evaluated.

Visual Reinforcement Audiometry

Visual reinforcement audiometry (VRA) is a type of pure tone test designed for children between the ages of 7 months to 2 or 3 years of age and those who are not able to perform traditional testing due to developmental limitations. VRA is a behavioral hearing test that trains a person to respond to sound.

During testing, the child will sit on the parent’s lap in a sound booth. Speech sounds and tones will be presented through speakers located in the corners of the sound booth. A head turn or eye shift response is reinforced by lighting an animated toy situated above the speaker. To determine the child’s hearing sensitivity, the intensity of the signal will be decreased until a child’s minimum hearing threshold is reached. VRA results obtained through speakers represent the hearing of the better ear, if a difference in hearing between ears exists.

Conditioned Play Audiometry

Conditioned play audiometry (CPA) is a type of pure tone test designed for patients who are not developmentally able to perform traditional hearing tests. CPA is typically used with children from 3 to 5 years of age and may be performed while wearing foam inserts or headphones or using speakers in the sound field.

During CPA testing, the child will be seated in the sound booth and will be shown how to perform a repetitive play task, such as dropping a block into a bucket, each time he or she hears a sound. Once the child is conditioned to the task, the intensity of the signal will be decreased until the softest sound the child can hear is found.

Acoustic Reflex Testing

Acoustic reflex testing is an objective test used to measure an involuntary reflexive response that occurs in the middle ear in response to a high intensity sound. This test is most commonly completed simultaneously with the tympanogram.

You will be asked to sit quietly while loud sounds of different pitches are sent into the ear canal. The level at which a reflex occurs is called the acoustic reflex threshold. This level will be recorded for each of the different pitches.

The results of the acoustic reflex test provide additional information about one’s hearing. The results are useful in determining consistency of hearing test results, especially if the reliability of other responses are questionable. The results also give insight into patients with central nervous system dysfunction.

Otoacoustic Emissions

Otoacoustic emissions (OAE) testing is an objective test used to provide information related to the function of the outer hair cells of the inner ear. OAE’s are routinely used in newborn hearing screening programs and in the pediatric population.

During OAE testing, a series of sounds will be presented through a small probe that fits in the ear canal. The probe contains a tiny speaker, that presents sound to the ear, and a microphone, that measures an emission (“echo”) from the ear. OAE results verify behavioral responses and provide additional frequency-specific information for each ear.

Acoustic Immittance

Acoustic immittance testing involves tympanometry, which evaluates eardrum mobility and middle ear function, and the acoustic reflex, which measures a middle ear muscle reflex.

Tympanometry measures the movement of the eardrum. While the patient is seated, a small probe-type tip is placed at the opening of the ear canal, creating a seal. The patient may hear a humming sound and feel a change in pressure in the ear. The information obtained is used in the diagnosis of middle ear disease or other problems that might affect movement of the eardrum. In addition, if the child has pressure equalizing tubes, this test will help determine if the tubes are functioning properly.

The acoustic reflex test measures middle ear involuntary muscle contractions. It is used to find what part of the ear may be involved in the hearing loss and help determine the type of hearing problem.