Special Education Resources

Hearing Tests Available for Newborn Infants and Young Children

By Paula Rosenthal

Modern technology has enabled audiologists to test the hearing of newborn infants and children with great accuracy. Unfortunately, many parents and medical professionals are still unaware of these tests. A hearing problem is usually suspected when the child does not meet appropriate language development milestones. Parents are often told by pediatricians to "wait and see" as there is a wide span of time that is considered normal development. Without early testing, most children with hearing loss are not diagnosed until after its initial onset, usually between the ages of 2 and 3. This late diagnosis results in significant speech, language and cognitive delays.

If you think your baby or child might not be hearing noises or speech, it is imperative that you act quickly. Refer to the extensive checklist, "Determining if Your Child Has a Hearing Loss," at http://www.hearingexchange.com/articles/determine.htm. Other warning signs of hearing loss in babies are listed below. Schedule a hearing test if your…

• baby does not startle or jump to loud sounds
• baby does not stop sucking or crying when there is a new sound
• three month old baby does not coo at times or make eye contact when talked to
• nine month old does not turn toward you when called from behind or make babbling sounds, such as "baba"
• one year old does not babble using a variety of consonant sounds (g, m, n, b, d)
• eighteen month old does not use single words to express his or her wants
• two year old does not repeat words or phrases and does not use short phrases when talking
• child has had many ear infections
• child uses gestures to communicate

If you checked any of the items on the list or any of these warning signs apply to your child, contact your pediatrician. Inquire about having your child tested with one or more of the following screenings or tests. You may need to consult a pediatric otologist, neurotologist or otolaryngologist. When a behavioral hearing test is recommended, every effort should be made to find an audiologist with significant experience testing young children. Often, schools for deaf and hard of hearing children have audiologists on staff.

Below are the different types of screenings and tests for babies and children.

Otoacoustic Emissions (OAE)

Otoacoustic emissions are sounds produced by the normally functioning inner ear. The OAE is typically used as a preliminary screening test. The procedure involves placing a small probe in the outer ear canal with the patient sitting still and quietly. A computer analyzes the emissions or lack thereof. This test does not require the child's active participation and usually takes about 15 minutes.

Auditory Brainstem Response (ABR) or Brainstem Auditory Evoked Response (BAER)

This test consists of sounds that are presented to a child's ears through earphones. Small electrodes are taped to the child's head and a computer analyzes responses. The infant or child must be completely still and is often sedated for this test unless asleep. Testing usually takes less than one hour. This is an expensive and highly specialized test requiring an experienced professional.

Behavioral Tests

Behavioral hearing tests are used with children who are able to respond to sounds either by turning their head or by playing a game. For young children there are usually two evaluators, an audiologist outside the sound booth monitoring the testing and another one inside who plays games with the child. Sometimes a parent is allowed inside the booth as well. Testing usually takes less than one hour.

Behavioral tests offer three important types of information. They measure the degree of hearing loss. They also assist in locating the source of the problem. These tests can also indicate how the hearing loss will affect the child's ability to communicate.

Types of Behavioral Testing

There are three types of behavioral tests:

• Threshold testing measures the quietest tones or speech that a child is able to hear.
• Word Recognition testing measures the child's ability to understand speech at comfortable loudness levels.
• Middle Ear testing searches for the presence of fluid or other middle ear dysfunction. The results are presented in a diagram called a tympanogram.

Infants with hearing loss can be fitted with hearing aids as early as four weeks of age. Children with severe and profound hearing losses may be eligible to receive a cochlear implant device as young as 11-12 months of age. With timely amplification and appropriate intervention, the likelihood of more normal speech and language development is significantly improved.

Children may need to be tested more than once, sometimes by different professionals. Obtaining an accurate diagnosis of hearing loss and appropriate fitting of amplification is not an easy task. It is a crucial time requiring knowledge, persistence and diligence. Swift intervention and diagnosis will help stem further delays of speech, language and cognitive development.

For further information visit these resources:

http://www.boystown.org/Btnrh/Chlc/index.htm - Center for Hearing Loss in Children at Boystown National Research Hospital
http://www.infanthearing.org - National Center for Hearing Assessment & Management (NCHAM)
http://www.asha.org/hearing/testing/index.cfm - American Speech-Language-Hearing Association (ASHA)
http://www.cdc.gov/nceh/cddh/ehdi.htm - Early Hearing Intervention & Detection Program (EHDI)
http://www.oticonus.com/OtiKids/index.html - Oticon's OtiKids web site
http://www.oae-ilo.co.uk - Otoacoustic Emissions Information Web Site

MEET YOUR PAL

Paula Rosenthal, J.D. is married and a mother of two young children. She, her husband and daughter are all hearing impaired. Her son has normal hearing. Paula is the founder and editor of HearingExchange, an online community for people with hearing loss, parents of deaf and hard of hearing children and professionals who work with them. For the latest news and information on hearing loss, send a blank email to HearingExchangeNews-subscribe@listbot.com.

© Copyright Paula Rosenthal, 2001. Reproduction of this article requires express, written permission of the author. Email reprints@hearingexchange.com with your request.