Detecting Hearing Loss in Children (cont.)
Who tests hearing in children?
A specialist who tests a person's hearing is called an audiologist. An audiologist has an advanced degree (minimum of master's degree) in diagnostic hearing testing techniques and auditory rehabilitation for children and adults. However, because testing hearing in children requires specific equipment, setup,
and training, not all audiologists test children. When a child is referred for a hearing evaluation, it should be confirmed at the time of scheduling that the testing audiologist has a pediatric specialty and the appropriate setup to test hearing in children.
Can very young children have their hearing tested?
A child of any age can be tested with the appropriate hearing test. The type
of test utilized depends on the child's age in years or developmental level.
Some hearing tests require no behavioral response from the child, while other
tests utilize games that entice a child's interest. The key is to find the
right test method for each child.
How is hearing tested in an older infant or young child who cannot
follow specific instructions?
Cooperative and alert infants or young children (ages 5 months to 2 and a half years)
are frequently tested using a method called visual reinforcement audiometry (VRA).
For this test, the child sits on a caregiver's lap in the center of a room.
Speakers are situated to the child's right and left side. The speakers have
toys (usually mounted inside boxes) hung below, which can be animated by the
tester. The child is then "conditioned" to turn his or her head toward the
side from which the sound is presented. When the child turns to the correct
side, the toy is lit up, providing positive reinforcement that encourages the
child to continue participating in the task. Children (and adults) will
instinctively turn toward a novel sound without having to think about the
response, which is why this test is effective for children as young as 5
months of age. This method can also be used with small insert earphones, which allow
the hearing of each ear to be tested individually. Below is a diagram of the
setup for the VRA test.
There are, however, some limitations to the VRA test. For an accurate test,
the child must participate and needs to be cooperative and alert. Additionally,
if only speakers are used for testing, the results can only be used to predict
hearing for the "better" ear. There is no way to tell if both ears are
hearing the test sounds, or if only one ear is hearing all of the sounds, unless
a device is utilized to isolate the ears (for example, earphones). It is not unusual,
however, to achieve test results for individual ear information by having the
child wear earphones during portions of the VRA test. The ability to localize
sound even with one impaired ear can be quite good. Often, otoacoustic emission (OAE)
tests are completed in conjunction with VRA testing to obtain
some ear-specific results (OAE tests will be discussed later in this article).
Children 3-5 years of age who are capable of more complicated tasks are
often tested using a technique called play audiometry, in which sounds are
paired with a specific response or task. For example, a child is taught to hold
a peg next to his or her cheek. When the child hears the sound, the child places
the peg on a Peg-Board.
Speech testing can be completed using pictures, for example, the child points
to the correct picture as the tester's voice is presented at softer and softer
levels. Once again, the child needs to be a willing participant. The advantage
of this format is that results obtained are often as detailed as an adult test
session.
Next: How can hearing be assessed in a child who is unable to cooperate? »
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