Your child’s quality of life and development vitally depends on hearing. Hearing helps your child learn to read, to appreciate music and to receive warnings of approaching harm. Without good hearing, your child will have difficulty coping with many of life’s challenges.
A comprehensive hearing evaluation can be completed at any age if you have ANY suspicion that a hearing problem exists. Trust your instincts: research has shown that when parents suspect a hearing problem, they are correct about 70% of the time!
A case history and examination of the ear with the use of an otoscope are essential. An audiological evaluation determines if a hearing loss exists in one ear or both ears at frequencies (pitches) that are critical to normal speech and language development. The evaluation also determines if the hearing loss is conductive (potentially medically treatable) or sensorineural (usually permanent and not medically treatable).
Here are some of the audiological procedures that may be included in evaluating your child’s hearing:
- Conventional Audiometry. In this type of hearing test, the audiologist presents speech sounds and pure tones at different pitches and loudness levels. The child is required to respond to the softest tones heard and to repeat words (or point to pictures of words).
- Behavioral Observation Audiometry (BOA). In this type of hearing test, the audiologist closely observes the infant’s behavior and facial expressions to determine when sounds that are presented through speakers are heard. The audiologist is well-trained to recognize such behaviors which might include changes in sucking patterns, widening of the eyes, or searching for the source of the sound. This type of test must be used in conjunction with other supporting tests.
- Visual Reinforcement Audiometry (VRA). In this type of hearing test, the audiologist directs the child’s attention toward a toy that lights up and moves when the child looks in response to a sound. This type of test is typically used for infants and children ages six months to two years.
- Play Audiometry. During this test, the audiologist conditions the patient to respond with some play action, such as putting blocks in a container or building a chain, whenever a sound is heard.
- Tympanometry. This test measures the movement of the eardrum and the ability of the middle ear to conduct sound to the inner ear. It is usually performed along with otoacoustic emissions and/or acoustic reflexes (see below).
- Acoustic Reflexes. In a normal-hearing ear, the stapedius muscle in the middle ear contracts in response to loud sounds presented at levels of about 70-100 dB (decibels). In this test, the audiologist presents tones at these levels and determines whether an acoustic reflex is present or absent.
- Otoacoustic Emissions (OAE). With this test, a probe in the ear canal measures sounds created by the inner ear in response to sounds presented by the audiologist. If the response is absent, a hearing loss may be present.
- Auditory Brainstem Response (ABR). For this test, sensors are pasted and taped on the head to measure and record the brain’s direct response to sound. Because no active response is required, it is often used with infants and very young children. It can even be done when the child is asleep.
Audiological management is crucial for children who have a history of otitis media (ear infections) with accompanying hearing loss. It is critical for these children to undergo a multi-disciplinary treatment approach which may include, in addition to the audiologist, the primary care provider, pediatrician, ear-nose-throat (ENT) physician, speech-language pathologist, and others. These children should receive regular, periodic hearing evaluations by a licensed audiologist, even when they appear to be symptom-free. In particular, hearing evaluations should be completed at the onset of the school year and at least once during the winter months for students in preschool and elementary school.