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Pediatric Evaluations

Proper evaluation by a qualified pediatric audiologist specializing in pediatric assessment is essential for a young child. No child is too young to have a hearing test and early detection of hearing loss is very important to the child's speech and language development. At Staten Island Hearing and Balance Center, specialized objective and behavioral test protocols are available for infants and young children and our pediatric test suite is fully equipped to meet the needs of children of all ages.

How common is hearing loss among children?

Hearing loss is the number one birth defect in America. Every day in the United States 33 babies are born with permanent hearing loss. Of those babies, approximately 1 in 1,000 is born profoundly deaf with another 2-3 in 1,000 babies born with partial hearing loss. Only half of those babies have a known risk factor for hearing loss.

What are the effects of hearing loss on children?

Early detection and intervention are two of the most important factors in the successful treatment of hearing loss in children. For example, when hearing loss is detected beyond the first few months of life, the most critical time for stimulating the auditory neural pathways is lost. This significantly impacts speech and language development. Thus, the Joint Committee on Infant Hearing (JCIH) and U.S. Public Health Services Healthy People 2010 heath objectives recommend that all newborns be screened for hearing loss by 1 month of age, receive diagnostic follow-up by three months, and be enrolled in appropriate early intervention services by 6 months of age.

Should my child have a hearing evaluation?

If your newborn did not pass a newborn hearing screening in either one or both ears, it is recommended that your baby receive one follow up re-screening by 1 month of age. If your newborn did not pass a second hearing screening after hospital discharge, it is then recommended that your baby receive a diagnostic evaluation prior to 3 months of age. Also, parents are often good judges of their children's hearing status. If you suspect hearing loss or if your child has any of the risk factors listed below, then hearing testing is strongly recommended. In addition, if your child exhibits a speech and language delay, then hearing testing is also highly recommended.

Risk factors which increase the chances of a child having hearing loss:

  • Family history of childhood hearing loss
  • > 48 hour Neonatal Intensive Care Unit (NICU) hospitalization at birth
  • Treatment with potentially ototoxic medications (usually IV antibiotics given due to infection)
  • Hyperbilirubinemia (requiring exchange transfusion)
  • Abnormalities of the ear, head, or neck, which are present at birth
  • Bacterial meningitis
  • Congenital infections such as rubella, herpes, toxoplasmosis, cytomegalovirus (CMV), which are present at birth
  • Syndromes such as Down, Usher, Turner
  • Head trauma
  • Neurodegenerative disorders

If you have any doubt about your child’s status for the above factors, please contact your pediatrician.

Is my child old enough to have a hearing test?

Yes! No child is too young to have a hearing test. Even a newborn can undergo hearing testing. Hearing levels of children are evaluated using either "behavioral" test methods or "physiologic" test methods. Behavioral test methods require the child to respond in some manner to different sounds. Physiologic test methods rely on technology to evaluate different parts of the hearing system without a behavioral response from the child. However, physiologic measures do require that the child be quiet and still or even asleep during testing. Often, a combination of behavioral and physiologic techniques is used.

How is a child’s hearing evaluated?

Behavioral test methods include Visual Reinforcement Audiometry (VRA), Conditioned Play Audiometry (CPA), and Conventional Audiometry. The goal of all testing is to determine the softest levels of tones and speech that a child can hear. The softest sound a child can hear 50 percent of the time, is called a "threshold". Tones tested are focused around those important for speech and language development.

Visual Reinforcement Audiometry (VRA)

Generally completed with children approximately 7 months to 2.5 years of age. The child sits on a parent's lap in the sound booth, and is conditioned to turn his/her head toward a sound presented via a speaker or insert earphone. When the child turns his/her head to look for the sound, he/she is rewarded by a brief presentation of a lighted, moving toy, or video of a child-friendly movie. Using this technique, thresholds can be reliably measured for tones of various frequencies and for speech.

Conditioned Play Audiometry (CPA)

Generally completed with children approximately 2.5 to 5 years of age. The child is trained to perform a play activity each time a sound is heard. Activities might include putting a block in a bucket, placing a peg in a pegboard, etc. Using this technique, thresholds can be reliably measured for tones of various frequencies. Speech thresholds are typically obtained by having the child identify pictures or repeat words.

Conventional Audiometry: Generally completed with children age 6 years old and older. A child will respond by raising a hand or pushing a button when he/she hears a tone, and by repeating speech when asked. Testing is modified from typical adult procedures depending on a child's attention to the task and ability to respond reliably. Sometimes conventional audiometry is combined with play audiometry to keep the child's interest.

Physiologic test methods include otoacoustic emissions (OAE) and tympanometry.

Otoacoustic Emissions Test (OAE)

During the OAE test, sounds are presented to the child through a small probe placed in the ear canal while the child is asleep or sitting still. The probe measures the otoacoustic emission, which is thought to be generated by outer hair cells in the cochlea (inner ear). The emission travels from the inner ear, through the middle ear bones and eardrum, and into the ear canal. Your audiologists will explain in greater detail exactly what your child's OAE test results mean. The test is quick and painless, but the child must be very quiet for the test to be accurate.

Tympanometry/Impedance Test

One of the most common problems children have is middle ear infections, which can affect hearing to a significant degree. However, it can be difficult for parents to detect these problems because children often don't complain, and the amount of hearing loss may be very slight. These middle ear infections are termed "otitis media".

Tympanometry is one of the tests used to determine if your child has a problem with his/her middle ears. The test measures the function of the middle ear system, which includes the eardrum, middle ear bones, and eustachian tube. A small probe is placed in the ear canal and the air pressure is then slightly changed. Tympanometry can detect a possible hole in the eardrum, or if fluid may be present behind the eardrum. This test also provides information about eustachian tube function. It is quick and painless.