How Do We Test Kids’ Hearing?

From the American Academy of Audiology

2-3 in 1000 children are born with a significant hearing loss._[1] Children of any age can be evaluated for hearing loss.

Hearing loss can lead to significant difficulties with understanding speech and language, academic performance, and emotional challenges.  Early identification of hearing loss can reduce these effects._[2] Hearing can be evaluated at any age. There are two main types of testing: objective and behavioral.

Objective Hearing Tests

Objective hearing tests are done for those who cannot reliably respond on their own during a behavioral hearing test. Behavioral testing is typically used with older infants and small children.  There are two types of common objective hearing tests: Otoacoustic Emissions (OAEs), Auditory Brainstem Response (ABR). Either of these may have been done in the hospital after your child was born as his or her newborn hearing screen.

• Otoacoustic emissions are sounds recorded from the ear.  The tester puts a small probe in the ear, and the child hears a series of sounds.  The test equipment records the response from the ear without the child having to respond.  An abnormal otoacoustic emissions test indicates either a hearing loss or perhaps fluid in the ear (such as an ear infection).
• Auditory brainstem responses record the neural response to sound.  Sticker electrodes are placed on the child’s head, and a sound is played in the ears.  The audiologist records the brain’s response to this sound and can provide an estimate of the child’s hearing loss.

It is important to remember that objective hearing tests do not tell audiologists what the child actually hears, but confirms that the pathways needed to understand sound are functioning.  Once a child is old enough, he or she will be tested using behavioral tests.

Behavioral Hearing Tests

Once a child is approximately 6 months old, the audiologist will start to introduce behavioral testing.  There are different types of tests based on the age and capabilities of the child.

• Visual Reinforcement Audiometry (VRA) is typically used for children ranging from 6 months to 2 years of age.  The child is trained to turn toward a reward (puppet, video) when he or she hears a sound.
• Conditioned Play Audiometry (CPA) is used for children between 2 and 5 years of age.  The child is taught to play a listening game such as putting a block in a bucket when he or she hears a sound.
• Conventional Audiometry is used for children 5 and older.  The child is asked to raise his or her hand, push a button, or say “I hear it” when he or she hears a sound.

Children with suspected hearing loss should be evaluated as soon as possible.  Audiologists are able to provide reliable information about hearing loss for children of any age.

Role of Audiologists

Audiologists identify, diagnose, and provide treatment options for patients of any age with hearing loss.  They work closely with physicians, when necessary, and are an important part of the management team.

[1] Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss – United States, 1999-2007. MMWR Morb Mortal Wkly Rep. 2010; 59(8): 220-223.

[2] Ching TYC et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017; 140(3): e20164274.