General Information
Infants can be tested as early as a few hours following their birth. Because hearing loss can be present for many different reasons, early documentation and early detection of hearing loss is a key component in the habilitation and success of a child.
The Auditory system is a primary source of information intake for a child. Learning begins with “hearing” sounds and progresses through stages of localization of sounds, identification of sounds, assessment of sounds for categorization, to a final comprehension of sounds for utilization. Once this comprehension is achieved, further auditory learning continues to allow the child to learn to “hear” for repetition and communication.
Working with young children is a challenge, especially when trying to obtain an accurate assessment of their hearing system. At NJ HHC we schedule a minimum of one hour for each child. Traditional and specialized techniques are employed to obtain the most accurate results.
Who should be tested?
• Children with recurrent ear infections/otitis media, especially from early infancy
• Children demonstrating speech and/or language delays
• Children demonstrating difficulty attending, listening, or focusing in a classroom
• Children from families with a hereditary incidence of hearing loss
• Children with significant birth histories
• Children with inconsistent listening and hearing behaviors
Behavioral Audiometry
Audiometric testing performed in a sound treated booth requires some participation from the patient to obtain information pertaining to their hearing system. This is accomplished using one or a combination of the following techniques:
Visual Reinforcement Audiometry VRA is generally used with infants and young toddlers beginning at 6 months of age. This depends on the ability of an infant to hold up their head and to localize to sound sources. Visual reinforcers are used following the presentations of sounds. In some cases the technique is used with older children who have developmental disabilities or children who exhibit behavioral difficulties.
Conditioned Play Audiometry
CPA uses a conditioning technique having the child perform a task in association with the detection of a tone or speech stimulus. In many cases the child is asked to place an object (usually a block or a ring) into a bucket following the presentation of a tone. A wide variety of other “play” tasks can be performed depending upon the child’s attention span and aptitude for the task. In some instances the child can perform the task and a complete audiogram will be obtained under headphones. The task is varied as needed to keep the child’s interest in order to obtain as much information as possible regarding the status of the peripheral hearing system. This Conditioning Play task is usually used with children from ages 3 and older, depending upon their maturity, attending ability, and developmental capabilities. In some instances, children as young as 21/2 can be tested using this technique. In both the VRA and CPA technique, headphone placement is attempted. Many of the younger children refuse the placement, either removing the headset as soon as you place it on their heads. Others may refuse the headset near their ears. In other cases, children may allow placement, but do not respond to any-stimuli with the headphones on their head. With younger children, part of our goal is to determine if they “hear”. If a child “hears” within a normal range, even with only one ear, it will be adequate for them to pick up the basic speech, language, and hearing skills for general development. Further testing is then recommended to obtain ear specific hearing information prior to placement in any formal school program.
Traditional Audiometry
This method is used with our children from approximately 4 years of age and older. Many of the children are attending nursery school or Pre-Kindergarten programs and are accustomed to raising their hands to respond to a request The testing is performed under headphones for ear specific information. This is done to rule out any subtle or unilateral hearing loss which will be significant to the child’s academic functioning.
Brainstem Auditory Evoked Response Testing (BAER)
Early identification of hearing loss has been shown to be crucial in a child’s development of language and speech skills. Newborn babies can be tested within hours of their birth to determine if their auditory nerve is functioning properly. The BAER test is a computerized test performed on infants up to approximately 6 months of age and who are too young to participate in behavioral audiometry. At NJ HHC, we use a non-sedation, natural sleep protocol. This procedure is also used for older children as needed and on the “difficult to test” population.
