Detecting Hearing Loss in Children

  • Author:
    Jillyen E. Kibby, MA, CCC-A

    Ms. Kibby received her master's degree in Audiology with honors from California State University, Long Beach, and is currently pursuing her doctorate at the University of Florida. She completed her clinical fellowship and spent seven years at Texas Children's Hospital in Houston, where she trained for her pediatric specialty.

  • Author: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: James K. Bredenkamp, MD, FACS
    James K. Bredenkamp, MD, FACS

    James K. Bredenkamp, MD, FACS

    Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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.

Visual Reinforcement Audiometry Photo - Hearing Loss in Children
Play Audiometry Photo - Hearing Loss in Children

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.

VRA Setup Illustration - Hearing Loss in Children
VRA Setup Illustration - Hearing Loss in Children

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.

Play Audiometry Photo - Hearing Loss in Children
Play Audiometry Photo - Hearing Loss in Children

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.

Medically Reviewed by a Doctor on 9/15/2016

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