|between 0-3 months, the child:||between 3-6 months, the child:|
|between 6-9 months, the child:||between 9-12 months, the child:|
- Otoacoustic emission (OAE) testing
- Auditory brainstem response (ABR) testing or Brainstem Auditory Evoked Response (BAER) testing
Pure tone testing, represented by an audiogram, is the foundation of an audiological evaluation. Pure tone test results are used to confirm normal hearing or describe the configuration and severity of hearing loss. Most pure tone testing is performed in a sound-treated booth using headphones, through which tones are delivered. The patient is instructed to raise her or his hand or push a button when a tone is detected. With children or special-needs adults, play or visually-reinforced techniques can be used to assess responses to the tones. Screening using pure tone testing by audiometer should be conducted in a sound-treated booth or quiet area.
The Human Hearing Chart to the left shows human hearing in hertz frequencies and the range that audiograms test. The range of hearing that the audiogram represents is shown on the chart in the shaded area labeled “AUDIOGRAM.” You can view a larger version of the Human Hearing Chart ( 1.0 MB). Image courtesy of Primary Children's Medical Center. Also, see an example of an Audiogram Showing Hearing Loss ( 269 KB).
Otoacoustic emission (OAE) testing is often used to test hearing in babies and small children and is the method most commonly used in newborn screening programs. The OAE involves placing a small probe in the baby’s ear that measures an active response, generated from the inner ear or cochlea, to clicks presented in the frequency range of about 800-4000 Hz. This test can only determine if normal cochlear function is present – it cannot specify the degree (mild, moderate, severe, or profound) or type (conductive or sensorineural) of hearing loss, if present. The range of hearing tested by OAE is shown on the human hearing chart in the shaded box labeled “OAE” (top near the middle). Many pediatricians and early intervention specialists use OAE to screen for hearing loss.
When conventional testing cannot be done, the ABR (aka Brainstem Auditory Evoked Response or BAER) is used. This is especially helpful with young children or older children with developmental delays that make behavioral testing unreliable. It can be performed on young infants during a natural sleep state. For older infants and toddlers, it is usually done with sedation because a child must be completely still during the test. ABR involves recording the brain’s activity in response to clicking sounds, in a frequency range from 500-4000 Hz, delivered to the child’s ear. The intensity of the sound can be increased up to about 105 dB. Compared with the broad range of human hearing, the frequency range of this test is somewhat narrow. However, the range that is tested encompasses the common frequencies that are needed for speech and language development. The ABR is not a hearing test but rather a test of the auditory-neural response to sound. ABR test reports may be complex but will include a summary that should include the clinical relevant findings and their implications for hearing and follow-up. See an example of a Child ABR Report ( 40 KB).
Infant receiving an ABR hearing test. Image
from the Provincial Health Servces Authority
of Canada website. Permission requested.
Normal adult ABR curves. Reprinted with permission from Journey into the World of Hearing, www.cochlea.org, R. Pujol et al., NeurOreille Montpelier.
American Academy of Audiology
Resources for professionals who test, treat, and provide care to the deaf or hard of hearing.
Utah Medicaid Audiology Provider Manual
Utah Medicaid Program, past and current Audiology Provider Manuals.
Genetics in Primary Care Institute (AAP)
The goal of this site is to increase collaboration in the care of children with known or suspected genetic disorders. Includes health supervision guidelines and other useful resources; a collaboration among the Health Resources & Services Administration, the Maternal and Child Health Bureau, and the American Academy of Pediatrics.
Family Voices is a national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs. Locate centers by state, F2F HICs (Family-to-Family Health Information Centers).
Utah Parent Center
A non-profit organization that provides training, information, referral, and assistance to parents of children and youth with all disabilities including physical, mental, hearing, vision, learning, behavioral, and emotional. Staff consists primarily of parents of children and youth with disabilities.
AUDIENT Alliance for Accessible Hearing Care
The AUDIENT Alliance for Accessible Hearing Care Program is designed for individuals whose income is above the government's established poverty levels, but still find it difficult to afford quality hearing care.
Hearing Tests (My Baby's Hearing)
Overview of hearing testing in children; Boys Town National Research Hospital.
Hearing Loss, Genetics, and Your Child Brochure (ACMG) ( 1.5 MB)
Two-page brochure for families about children with hearing loss and determining a genetic cause; American College of Medical Genetics.
Hearing Loss, Genetics, and Your Child Brochure (ACMG) (Spanish) ( 1.4 MB)
Two-page brochure, in Spanish, with information for families about hearing loss in children and determining genetic causes; American College of Medical Genetics.
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