Our hearing is just as important for our well-being as our teeth and eyes, and should be checked regularly. Even if you’ve never noticed hearing difficulties, scheduling a baseline hearing test is a good idea. This baseline evaluation will give you definitive information about your hearing abilities, and allow your audiologist to track any changes in hearing over time.
Adult Hearing Evaluations
To evaluate the hearing status of older children and adults, a variety of tests are used. For the basic test, the patient responds to auditory stimuli by raising their hand or pressing a button; different pitches (frequencies) and loudness (intensity) will be used to determine the patient’s hearing levels.
Air Conduction Testing
During the air conduction test you will sit in a quiet booth wearing headphones. Tones will be played into each ear of the headphone. You will be asked to indicate when you hear a tone in each ear by pressing a button or raising your hand, and the audiologist will determine the softest tones you can hear.
Bone Conduction Testing
In a bone conduction test, a device is placed behind your ear instead of headphones. This device uses vibration to send tones straight to your inner ear, bypassing the outer and middle ear. Similar to the air conduction test, you will indicate when you hear a tone.
In speech testing, you will be asked to repeat a series of single words, to determine both the softest levels at which you can hear them, and how clearly you can hear them when they are presented at a comfortable volume.
Additional diagnostic tests include adult versions of otoacoustic emissions, averaged brainstem response and tympanometry with acoustic reflexes.
Pediatric Hearing Evaluations
We test the hearing of newborns through adolescence with a variety of testing techniques. Testing usually takes 45-60 minutes per child.
Auditory Brainstem Response (ABR)
The ABR test is used for newborns through 6 months of age. It is an electroacoustic test which measures the response of the hearing (auditory) nerve. Sensors are placed on the child’s forehead and behind each ear, and small earphones are placed in the ears. Sounds will be played through the earphones and the response of the auditory nerve is measured to determine the child’s hearing levels.
Otoacoustic Emissions (OAE)
Otoacoustic emissions are used for newborns through adulthood. OAE is an electroacoustic test which measures the function of the outer hair cells (integrity of the cochlea). A small earphone is placed in the ear through which sounds will be played. Responses from the cochlea are measured to determine the child’s hearing levels.
Middle-ear analysis in infants younger than 6 months requires tympanometry using a special 1000Hz probe tone, different acoustic reflex stimuli and different normative data. A small soft probe is placed in the outer ear canal. Test results provide information about middle-ear fluid, Eustachian Tube function and acoustic reflex integrity.
Visual Response Audiometry (VRA)
VRA is used for children 7-24 months of age. The child will sit on the caregiver’s lap between two speakers or wearing headphones. The audiologist will present sounds. The child will be taught to turn their head in response to the sound and will be rewarded with a toy that lights up. The child’s attention will then be brought back to center and the sequence will start again. Different pitches (frequencies) and loudness (intensity) will be used to determine the child’s hearing levels.
Visually Reinforced Operant Conditioning Audiometry (VROCA)
VROCA is used for 24-36 months of age. The child will wear headphones and will be taught to push a button or other device in response to the sound and will be rewarded with a toy that lights up. The child’s attention will then be brought back to center and the sequence will start again. Different pitches (frequencies) and loudness (intensity) will be used to determine the child’s hearing levels.
Conditioned Play Audiometry (CPA)
CPA is used for children 3-6 years of age. The child will wear headphones and will be taught to place a block or other toy in a bin in response to the sound. Different pitches (frequencies) and loudness (intensity) will be used to determine the child’s hearing levels.
Conventional Audiometry (CA)
Conventional audiometry is used for children who no longer need conditioning tasks. The patient responds to auditory stimuli by raising their hand. Different pitches (frequencies) and loudness (intensity) will be used to determine the child’s hearing levels.
Auditory Processing Disorders (APD) Screening
An auditory processing disorder is the inability or impaired ability to recognize or comprehend information by hearing even though a person has normal intelligence and normal hearing sensitivity. APD testing is often recommended for school-aged children who have difficulty learning and listening. An APD evaluation assesses the auditory perceptual skills as they relate to communication and academic performance. Based on screening test results, our practitioners will recommend the appropriate follow up testing and/or therapy.
Newborn Hearing Screening and Diagnostics
Approximately 3 in 1000 babies are born with a hearing loss (CDC, 2004). Hearing loss in children can negatively impact speech and language development (Yoshinaga-Itano et al., 1998). Early detection, diagnosis, and intervention of hearing loss is essential to developing normal speech and language skills. The National Institutes of Health’s (NIH) Consensus Development Conference (CDC) on Early Identification of Hearing Loss in 1993 concluded that all infants should be screened for hearing loss prior to hospital discharge. The Early Hearing Loss, Detection, Diagnosis, and Intervention (EHDDI) Program at the Washington State Department of Health provides protocols for screening and diagnostic evaluation of newborns’ hearing.
One of the primary goals of the EHDDI program is to ensure that all infants born in the state of Washington:
- Are screened for hearing loss before hospital discharge, or by one month of age
- Receive diagnostic audiological evaluation by three months of age if needed
- Are enrolled in early intervention services by six months of age if needed
This is also known as the 1-3-6 goal.
Universal Newborn Hearing Screening (UNHS) is not mandated by law in Washington State; however, all of the birthing hospitals in the state have UNHS programs and perform newborn hearing screens. An electrophysiological test, either automated Auditory Brainstem Response (ABR) or Otoacoustic Emissions (OAE), is used to evaluate the newborn’s hearing. If the baby passes the test they do not need to receive further hearing tests, unless they have risk factors for hearing loss, experience chronic ear infections, or if there is concern regarding their hearing. If the baby does not pass, or refers, on the hearing screen for one or both ears, it is recommended that they receive a diagnostic hearing evaluation.
There are many risk indicators for hearing loss. The five main risk factors that hospitals record when screening the infants’ hearing are:
- Stay of 48 hours or more in a Neonatal Intensive Care Unit (NICU)
- Diagnosis of a syndrome associated with hearing loss
- Family history of permanent childhood sensorineural hearing loss
- Craniofacial anomalies such as cleft lip or palate, ear tags or pits
- Maternal illness such as infection with rubella or cytomegalovirus (CMV)
Seattle Hearing and Balance Center provides Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE) evaluations to test infants’ hearing. ABR and OAE testing can be used to test newborns through adults. They are physiologic tests which allow testing of the auditory nerve and the outer hair cells of the cochlea. Although ABR and OAE cannot tell us how the child will use their hearing, it tells us how the outer hair cells and auditory nerve respond to auditory stimuli.
For more information on Hearing Health, visit the Better Hearing Institute http://www.betterhearing.org/.