Anita Stein-Meyers, Au.D., CCC-A
As a pediatric audiologist at the Center for Hearing and Communication, I've been providing audiological services, including hearing testing, to children of all ages for over 35 years. I know parents typically have a lot of questions in advance of their child's audiological evaluation. So I thought I would address those questions and offer tips for getting the most out of your child's hearing test.
No Child Is Too Young To Be Tested
There are a variety of reasons why an audiological evaluation (or hearing test) might be recommended for a child. They can include a referral after a newborn hearing screening, concern regarding delays in speech development or a history of ear infections. No child is too young to be tested; however, the type of testing will vary depending on the age of your child or their abilities.
It's important that hearing testing for children be done by a pediatric audiologist because we have specific training and experience in test techniques and interpretation of testing, as well as a familiarity with child development. Of course every child is different, and you know your child best, so you're involvement in the process is essential.
Here's a snapshot of the different types of tests available for children (and adults) along with some recommended steps to take in advance of your appointment.
Planning Your Visit
Be prepared to answer questions about your family history, your child’s birth and overall development and provide any other previous evaluations that have been conducted.
Other steps to consider in advance:
Siblings, ideally, should stay at home to reduce potential distractions.
Do not bring a child who is sick or not feeling well. This can affect test results as well as affect your child’s ability to focus on required tasks.
For older children, prepare them for their visit by talking to them about having their ears checked (taking pictures of their ears, listening to sounds, playing listening games, etc.).
Consider demonstrating what it is like to wear headphones or earbuds.
Types of Tests
For All Ages
Otoscopy: A visual examination of the ear canals with light.
Middle Ear Measurements (Tympanograms, Acoustic Reflexes): Testing the movement of the eardrums and how the middle ear muscles work by placing a soft earplug in the ear that presents air and sounds.
Inner Ear Measurements (Otoacoustic Emissions (OAE)): Testing how parts of the inner ear respond to sound by placing a soft earplug in the ear.
Air and Bone Conduction Measurements: Testing to determine the softest levels your child can hear different sounds. Your child will wear a soft earplug or headphone and a headband that presents these sounds. These tests may take place using different age-based methods.
Speech Measurements: Testing to determine the softest levels your child can hear speech and how clearly they understand words. A child may be asked to repeat back sounds or words, point to toys, body parts or point to pictures.
For Children Birth to 6-9 Months Old
ABR, Auditory Brainstem Response Testing: A physiological test that measures the brain’s response to sounds. Sounds are presented to the ear while small electrodes placed on the head record the responses. This test is painless and completed most easily and reliably when a child is sleeping. This test may take anywhere from 2-3 hours and is usually completed in one session. Occasionally, it may require more than one test session. We've found that when you keep your infant hungry and tired prior to the appointment, they are more likely to eat and quickly fall asleep at the appointment and allow for the testing to take place. If an infant cannot fall asleep naturally, they may need to be sedated for this test. We do not do this at CHC, and if it is necessary, we will refer you to a setting where this can be done.
For Children 6-9 Months to 2-2 ½ Years
VRA, Visual Reinforcement Audiometry: Children can be taught to respond to sounds by teaching them to turn and look in the direction of the sound when the sound is paired with a reward such as a mechanical toy or video. After a short practice, a variety of sounds can be presented at different volumes and their ability to “find or turn to the sound” is followed by this reward. With this test we can get a very accurate measurement of a child’s hearing.
For Children 2 ½ to 3 and Older
CPA, Conditioned Play Audiometry: Simply turning toward the sound for a reward becomes less interesting at this age and as children develop higher level thinking they can begin to understand how to play a “listening game” which would require them to demonstrate their response to hearing sounds by performing an activity. When playing a listening game, a child can be taught to put stickers on pictures, put pegs in a board, drop toys in a box, etc., every time a sound is heard. This will take time and practice and perhaps a new and interesting activity or game can be used as a “listening game.”
On occasion the task may be taught at an appointment but may need continued practice at home to maintain a level of understanding. A toy that may be used at home can be brought to the appointment to maintain familiarity with the task. Suggestions for practice may include using a noisemaker to make a sound and instruct your child to wait until they hear the sound before playing the game.
For Children Older Than 5 Years
Standard Audiometry: Most children by age five can begin to learn to take a hearing test by raising their hands when they hear sounds, much like an adult would for testing, but may still enjoy a play activity which can continue to be incorporated into testing.
With children of any age who have delays in various aspects of their development, a pediatric audiologist will modify the testing and test techniques to match your child’s abilities and level of understanding.
I hope you've found this information helpful. Please don't hesitate to contact me at firstname.lastname@example.org should you have additional questions about your child's audiological needs. And click below to request an appointment with a CHC pediatric audiologist.
If you read the piece on newborn hearing screening in The New York Times December 22, 2021, and would like to gain additional perspective, click here to read our comments.