Hearing Testing for Children

Our pediatric audiologists and Listening and Spoken Language Specialists will work closely with your family to provide a comprehensive and detailed assessment of your child’s hearing using a combination of the tests below. When you bring your child for his or her appointment, your audiologist will explain the hearing testing that is being completed, the results we obtain, and the recommendations we have to optimize your child’s well-being. We will also answer any questions you might have.

The auditory brainstem response (ABR) evaluation is a test that measures how well each ear responds to sound. Specifically, the ABR tells us how the ear and the nerve pathways from the ear to the brain respond to sound. This test is commonly performed with babies and children who cannot cooperate for a routine hearing test to be completed. The ABR is the standard test that is given to infants who do not pass the newborn hearing screening.

To complete this test, a pediatric audiologist will clean the skin on your baby’s forehead and behind his or her ears with a special face scrub and place small sensors on his or her head. Then, the sensors are connected to a computer, and small earphones are placed in your baby’s ears. While the audiologist is getting everything set up for the test, a Listening and Spoken Language Specialist will work with you to keep your child comfortable and happy. Your baby must be very still and quiet for the ABR test to be accurately completed. Typically, it is necessary for your baby to be asleep so accurate results can be obtained. Please do not let your baby sleep two to four hours before the ABR evaluation so he or she will be restful during the test.

Once your baby is asleep, the audiologist will deliver sounds through the earphones, and your baby’s responses will be measured for each of the different sounds. The audiologist will analyze the responses to determine whether the ears are detecting the sounds. The ABR evaluation is not a painful test, but it may take a long time to complete (i.e., 2-3 hours).  After the ABR test is completed, the audiologist will discuss the results and answer any questions you might have. The audiologist and Listening and Spoken Language Specialist will also provide recommendations based on the test results.

Behavioral audiological tests evaluate your child’s ability to respond to sounds, including speech and tones. The method in which the audiologist obtains this information varies depending on your child’s age and developmental abilities. Our audiologist will use either the visual reinforcement audiometry or the conditioned play audiometry for your child’s behavioral audiological assessment. Both of those assessments are explained below.

Beginning at about 6 months of age until about 2 to 3 years of age, a pediatric audiologist and Listening and Spoken Language Specialist will work together to test your child’s hearing with the use of visual reinforcement audiometry (VRA).  During VRA testing, sounds are presented to your child through earphones or speakers while he or she sits in a highchair or on your lap. When your child turns toward the sound, the audiologist will activate a video screen or animated toys to reward your child’s response. The Listening and Spoken Language Specialist will attempt to ensure your child is not turning toward the video screen or animated toys when sounds are not being presented. The Listening and Spoken Language Specialist will also maintain your child’s cooperation throughout the VRA test.

Beginning at about 2 to 3 years of age until your child is school-age, an audiologist and Listening and Spoken Language Specialist will often test your child’s hearing using an approach called conditioned play audiometry (CPA). During a CPA test, your child listens to sounds presented through earphones or speakers and plays a game, such as dropping a toy into a bucket or pushing a button to see his or her favorite movie character on a video screen, every time the sound is heard. The Listening and Spoken Language Specialist will sit in the test booth with your child and assist him or her in completing the CPA games.

Tympanometry is a test that evaluates the function of the middle ear and ear drum. To complete this test, the audiologist will place a small, soft earphone in your child’s ear and test how the middle ear and ear drum respond to sound while the air pressure changes in his or her ear canal. Tympanometry is quick and painless, but your child will need to remain still for a short time (usually less than a minute) for the test to be completed.

The acoustic reflex is the contraction of a small middle ear muscle in response to louder sounds. When the acoustic reflex occurs, the ear drum stiffens to protect the ear from loud sounds. To complete this test, the audiologist will play louder tones in your child’s ear and will determine whether the ear drum stiffens due to the muscle contraction. The acoustic reflex threshold test provides information about your child’s middle ear, the inner ear, and the hearing nerve. This test is quick and painless.

The otoacoustic emission test evaluates the function of the inner ear. When soft and medium-level sounds are presented to the ear, the inner ear (i.e., the cochlea) produces a sound that mimics the sound that is delivered to the ear. The sound that the inner ear produces (i.e., emits) is referred to as an otoacoustic emission (OAE).

To complete the OAE test, an audiologist will deliver sounds into your child’s ear canal with a small, soft earphone. The audiologist will determine whether the inner is producing an OAE (i.e., “echo) in response to the sound. It is unnecessary for your child to respond to the OAE test signals, so the OAE test may be completed while your child sleeps

In fact, the OAE responses produced by the ear are very small and can be difficult to measure when a child is noisy or restless. A Listening and Spoken Language Specialist will work with your child to make him or her feel comfortable, calm, and quiet during the OAE test.  After the OAE test is complete, the audiologist will discuss the results and answer any questions you might have.