Audiologic Tests for Infants and Children
| Developmental Age of Child . | Auditory Test/ Average Time . | Type of Measurement . | Test Procedures . | Advantages . | Limitations . |
|---|---|---|---|---|---|
| All ages | Evoked OAEs/10-min test | Physiologic test specifically measuring cochlear (outer hair cell) response to presentation of a stimulus; stimuli may be clicks (transient evoked OAEs) or tone pairs (distortion product OAEs) | Small probe containing a sensitive microphone is placed in the ear canal for stimulus delivery and response detection | Ear-specific results; not dependent on whether patient is asleep or awake; quick test time; screening test | Infant or child must be relatively inactive during the test; not a comprehensive test of hearing, because it does not assess cortical processing of sound; OAEs are very sensitive to middle-ear effusions and cerumen or vernix in the ear canal |
| Birth to 9 mo | Automated ABR/15-min test | Electrophysiologic measurement of activity in auditory nerve and brainstem pathways | Placement of electrodes on child's head detects neurologic response to auditory stimuli presented through earphones or ear inserts 1 ear at a time | Ear-specific results; responses not dependent on patient cooperation; screening test | Infant or child must remain quiet during the test (sedation is often required); not a comprehensive test of hearing, because it does not assess cortical processing of sound |
| 9 mo to 2.5 y | VRA/15- to 30-min test | Behavioral tests measuring responses of the child to speech and frequency-specific stimuli presented through speakers or insert earphones | Technique conditions the child to associate speech or frequency-specific stimuli with a reinforcer, such as a lighted toy or video clips; VRA requires a calibrated, sound-treated room | Assesses auditory perception of child; diagnostic test. | When performed with speakers, only assesses hearing of the better ear; not ear specific; if VRA is performed with insert, earphones can rule out a unilateral hearing loss |
| 2.5 to 4 y | Play audiometry/ 15–30 min | Behavioral test of auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibrator | Child is conditioned to respond when stimulus tone is heard, such as to put a peg in a pegboard or drop a block in a box | Ear-specific results; assesses auditory perception of child; screening or diagnostic test. | Attention span of child may limit the amount of information obtained |
| 4 y to adolescence | Conventional audiometry/15- to 30-min test | Behavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibrator | Patient is instructed to raise his or her hand when stimulus is heard | Ear-specific results; assesses auditory perception of patient; screening or diagnostic test | Depends on the level of understanding and cooperation of the child |
| All ages | Diagnostic ABR | Electrophysiologic measurement of activity in auditory nerve and brainstem pathways | Placement of electrodes on child's head detects auditory stimuli presented through insert earphones 1 ear at a time | Ear-specific results; multiple frequencies are tested, creating a map of hearing loss similar to an audiogram; responses not dependent on patient cooperation; diagnostic test | Infant or child must remain quiet during the test (sedation is often required); not a true test of hearing, because it does not assess cortical processing of sound |
| All ages | Tympanometry | Relative change in middle-ear compliance as air pressure is varied in the external auditory canal | Small probe placed in the ear canal and pressure varied in the ear canal | Tests for possible middle-ear pathology and pressure-equalization tube function | Not a test of hearing; depends on ear canal seal; high-frequency tone probe needed for infants younger than 6 mo |
| Developmental Age of Child . | Auditory Test/ Average Time . | Type of Measurement . | Test Procedures . | Advantages . | Limitations . |
|---|---|---|---|---|---|
| All ages | Evoked OAEs/10-min test | Physiologic test specifically measuring cochlear (outer hair cell) response to presentation of a stimulus; stimuli may be clicks (transient evoked OAEs) or tone pairs (distortion product OAEs) | Small probe containing a sensitive microphone is placed in the ear canal for stimulus delivery and response detection | Ear-specific results; not dependent on whether patient is asleep or awake; quick test time; screening test | Infant or child must be relatively inactive during the test; not a comprehensive test of hearing, because it does not assess cortical processing of sound; OAEs are very sensitive to middle-ear effusions and cerumen or vernix in the ear canal |
| Birth to 9 mo | Automated ABR/15-min test | Electrophysiologic measurement of activity in auditory nerve and brainstem pathways | Placement of electrodes on child's head detects neurologic response to auditory stimuli presented through earphones or ear inserts 1 ear at a time | Ear-specific results; responses not dependent on patient cooperation; screening test | Infant or child must remain quiet during the test (sedation is often required); not a comprehensive test of hearing, because it does not assess cortical processing of sound |
| 9 mo to 2.5 y | VRA/15- to 30-min test | Behavioral tests measuring responses of the child to speech and frequency-specific stimuli presented through speakers or insert earphones | Technique conditions the child to associate speech or frequency-specific stimuli with a reinforcer, such as a lighted toy or video clips; VRA requires a calibrated, sound-treated room | Assesses auditory perception of child; diagnostic test. | When performed with speakers, only assesses hearing of the better ear; not ear specific; if VRA is performed with insert, earphones can rule out a unilateral hearing loss |
| 2.5 to 4 y | Play audiometry/ 15–30 min | Behavioral test of auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibrator | Child is conditioned to respond when stimulus tone is heard, such as to put a peg in a pegboard or drop a block in a box | Ear-specific results; assesses auditory perception of child; screening or diagnostic test. | Attention span of child may limit the amount of information obtained |
| 4 y to adolescence | Conventional audiometry/15- to 30-min test | Behavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibrator | Patient is instructed to raise his or her hand when stimulus is heard | Ear-specific results; assesses auditory perception of patient; screening or diagnostic test | Depends on the level of understanding and cooperation of the child |
| All ages | Diagnostic ABR | Electrophysiologic measurement of activity in auditory nerve and brainstem pathways | Placement of electrodes on child's head detects auditory stimuli presented through insert earphones 1 ear at a time | Ear-specific results; multiple frequencies are tested, creating a map of hearing loss similar to an audiogram; responses not dependent on patient cooperation; diagnostic test | Infant or child must remain quiet during the test (sedation is often required); not a true test of hearing, because it does not assess cortical processing of sound |
| All ages | Tympanometry | Relative change in middle-ear compliance as air pressure is varied in the external auditory canal | Small probe placed in the ear canal and pressure varied in the ear canal | Tests for possible middle-ear pathology and pressure-equalization tube function | Not a test of hearing; depends on ear canal seal; high-frequency tone probe needed for infants younger than 6 mo |
Adapted with permission from: Bachmann KR, Arvedson JC. Pediatr Rev. 1998;19(5):155–165.