Pediatric Hearing Testing
Newborn Hearing Screening: In the state of New Jersey, all babies should have a newborn hearing screening prior to leaving the hospital. Any baby who does not pass the newborn hearing screening is required to have a follow-up hearing evaluation. The newborn hearing screening follow-up testing should be performed as soon as possible as it is important to diagnosis a hearing loss as early as possible to achieve age-appropriate speech, language, and learning milestones.
Infants less than 6 months of age cannot provide accurate behavioral responses to sound; therefore, the hearing test consists of objective measures which may include Auditory Brainstem Response (ABR) testing, Otoacoustic Emissions (OAE) testing, and tympanometry.
An audiological evaluation for children who are 6 months of age and older involves a combination of objective and behavioral measures. At our facility, we can perform hearing tests on individuals 6 months of age and older. The method of testing varies depending on the age and/or intellectual abilities of the individual. Behavioral measures aim to determine the lowest intensity level that the child responds to sounds in order to determine the degree of hearing; ideally testing is performed under earphones (if the child will tolerate it) in order to obtain ear specific responses. The sound stimuli can be presented through speakers if the child is intolerant to earphones but that method only provides a representative measure of the better hearing ear, if a difference between ears exists.
- Tympanometry: assesses the status of the middle ear. This test determines if there is any middle ear fluid, middle ear pressure, or a potential problem with the middle ear ossicles than can negatively affect hearing abilities
- Acoustic reflex testing: determines response of the stapedius muscle (in the middle ear) in response to a loud sound
- Otoacoustic Emissions (OAEs): measures the response of the inner hair cells in the cochlea to different tones. A normal response can be suggestive of hearing that is normal or near normal; an absent or abnormal response may be suggestive of hearing levels worse than a mild hearing loss. Abnormal responses may indicate that there is damage to the inner hair cells before it actually shows up as a hearing loss, such as in cases of noise exposure. This test cannot determine actual hearing levels.
- Auditory Brainstem Response (ABR) testing: monitors brain wave activity in response to sound to determine the degree of hearing while the baby is asleep. This test involves electrodes being placed on the head and ears and the patient hears a series of clicks or tones through earphones. It can also be performed on older children or adults who are inconsistent with their behavioral responses on other hearing test procedures or to rule out a retro-cochlear pathology. ABR testing is not performed at our facility.
- Visual reinforcement audiometry (VRA): typically used for children age 6 months to 3 years. This test involves the child being conditioned to turn his/her head in response to a sound and then being rewarded for looking with a visual stimulus (i.e. dancing stuffed animal).
- Conditioned play audiometry: typically used for children age 3-4 years. This procedure makes hearing testing a fun and interactive game. The child is instructed, for example, to throw a block into a bucket each time a sound is heard. There is positive social reinforcement (handclapping, smiles, “good job”, etc.) for performing the task.
- Conventional audiometry: typically used for children 5 years and up at which point the child is able to participate in traditional testing procedures. The child wears earphones and is instructed to raise a hand or push a button when a sound is heard.
- Speech testing is also performed with each of the above behavioral measures, if the child will participate, to ensure that the responses to speech stimuli correspond with responses to tonal stimuli
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