Pediatric Hearing Testing:
Early intervention of suspected hearing loss is key because treatment is more successful the earlier it is identified. That’s why every newborn is required to have a hearing screening performed before leaving the hospital.
If your baby doesn't have a screening before going home is important get their hearing checked within the first 3 month of life. Not passing a hearing screening after birth does not mean your child has hearing loss; it does mean that the baby should be retested within 3 months. If hearing loss is found then, treatment should begin right away.
Children should continue to have their hearing screened at their pediatric well visits. Hearing screening tests usually are done at:
- ages 4, 5, 6, 8, and 10 years
- the preteen years
- the teen years
Your child’s pediatrician will also check hearing any other time there's a concern. Tell your child’s pediatrician if you are concerned about a hearing problem.
Hearing is checked by a hearing specialist called an audiologist. The type of test they do depends on a child's age, development, and health. Many younger children get behavioral hearing tests. These tests check to see your child’s response to sounds like calibrated speech (speech that is played with a particular volume and intensity) and pure tones. A pure tone is a sound with a very specific pitch (frequency), like a note on a keyboard. During your child’s testing, the audiologist will watch for a behavioral response after a child hears a sound. Babies or toddlers may make eye movements or turn their head. Older kids may move a game piece in response to a sound, and a grade-schooler may raise their hand. Children also can respond to speech with activities like choosing a picture or repeating words softly. Other tests can be done to check hearing if a child is too young or not able to cooperate with behavioral testing. These tests look at how well the ear, nerves, and brain are working.
The ear gathers sounds from the environment and turns them into messages the brain can understand. Other tests, like tympanometry testing, will let the audiologist know how well their eardrum is moving and can help find middle ear problems, such as fluid behind the eardrum or a hole or tear in the eardrum. During this test, the audiologist puts a small probe with a rubber tip in the child’s ear. It sends a soft sound and a puff of air into the ear canal. Test results appear on a graph called a tympanogram. The shape of the graph tells how the eardrum is moving. But sometimes these messages won’t go through or are jumbled.
Another test an audiologist may perform to check to see if the cochlea (which creates the messages) is working properly is called and OAE test. OAE stands for otoacoustic emissions. During the test, your child’s audiologist puts soft earphones gently into each ear canal. The earphones make high and low sounds that are in different pitches. Then, the machine records the response made by the cochlea’s outer hair cells. Hospitals use OAE for newborn hearing screening. A baby that fails this screening will need a full hearing evaluation. Many middle ear problems like ear infection, fluid, or respiratory illness like a cold can cause results from this test to be poor. However, once the issue is resolved, this test should return to normal.
It is common for insurance companies to require a hearing evaluation for your child if you or your child’s pediatrician have concerns of speech delay. Insurance will want to rule out any hearing loss for your child prior to speech therapy beginning. They may also require testing as your child ages and still participates with speech therapy.
Baby Auditory Brainstem Response (ABR) Testing
Babies cannot respond or verbally communicate; an Auditory Brainstem Response (ABR) may be needed to determine their ability to hear. An auditory brainstem response (ABR) test is a safe and painless evaluation to see how the brain responds to sound stimulus. ABR testing provides health care providers information about possible hearing loss. ABR testing is required when a baby fails the newborn hearing screening at the hospital, or if they are too young to do a regular hearing test in a sound booth. An ABR is performed by an audiologist that places a small earphone in the child’s ears and places informational electrodes (small sensor stickers) behind the ears and on the forehead.
Clicking sounds and tones go through the earphones and electrodes measure how quickly the brain responds to the sound stimulus. An ABR test usually takes 1–2 hours, but the appointment may last about 3 hours. It is required for this test that your baby sleep through the duration of the testing. If a sleeping baby wakes up during the test or is unable to settle, you may be referred for a sedated ABR test. ABRs are safe, do not hurt, and do not have any side effects. If your child needs sedation, discuss the risks and benefits with your health care provider or sedation team before the test.