More than 24,000 children are born with hearing loss in the United States each year. Boys Town National Research Hospital is a national leader in the diagnosis and treatment of children with moderate to profound hearing loss.
Information on Hearing Loss - Identifying Hearing Loss in Children: Basic Evaluations
When parents notice a problem with their child's hearing, their child may need to have a hearing test and other evaluations. Some of these tests are described below, along with a discussion of why the test information is important to understanding and managing a child's hearing loss.
Audiological Evaluations
Behavioral Tests
Behavioral hearing evaluations are used with children who are old enough to respond to sounds either by turning their head or by playing a game. Behavioral testing typically takes less than 1 hour to perform.
Behavioral tests give three main pieces of information. First, they measure the degree or amount of hearing loss. Second, they can help in locating the problem-in the middle ear, inner ear or some combination of the two. Third, behavioral tests provide information about how the hearing loss will affect your child's ability to communicate. Sometimes testing indicates that a hearing aid could help a child. To see if this is true, behavioral testing is done while the child wears a hearing aid.
Behavioral tests usually include:
- Threshold testing-measures the quietest tones or speech that a child can hear
- Word recognition testing-measures a child's ability to understand speech at comfortable loudness levels
- Middle ear testing-as part of the behavioral evaluation, a child's middle ear might be tested for the presence of fluid or some other problem. (The results are presented in a diagram called a tympanogram.)
Auditory Brainstem Response Evaluation
For some infants and children, behavioral testing does not provide reliable results. In such cases, an Auditory Brainstem Response Test (ABR) may be recommended. The ABR test can provide useful information about the type and amount of hearing loss, the effect on communication abilities, and the functioning of the hearing nerve.
The ABR test consists of sounds that are presented to a child's ears through earphones while the child sleeps quietly in a crib or in a parent's arms. The responses are measured through small electrodes taped on the infant's head and then analyzed by computer. Testing usually takes less than 1 hour.
Otoacoustic Emissions
Another procedure, currently being developed as a screening test, measures otoacoustic emissions-sound that is "sent out" by the inner ear. A tiny microphone is placed in the ear canal and the sounds are analyzed by a computer. The test can help in determining if the child has a hearing loss. As with ABR testing, OAE testing does not require a child's active participation and usually takes about 15 minutes.
Vestibular Evaluation
The vestibular system is part of the inner ear and provides us with our sense of balance. It can be affected by some of the same problems that cause hearing loss. A vestibular evaluation may help confirm the cause of the hearing loss, and can provide information about the development of motor skills. There are several tests that could be recommended; all of them stimulate the vestibular system in some way and measure its responses by computer. Vestibular evaluations usually take about 1 hour to complete.
Medical Evaluations
Otolaryngology - An otolaryngologist (ear, nose and throat doctor) completes a medical evaluation of the hearing system and obtains a comprehensive medical history. If a hearing loss is present, the otolaryngologist will be able to determine if medical or surgical treatment can improve it. If a hearing aid is needed, this doctor provides medical approval for its prescription.Medical Genetics - The purpose of a medical genetics evaluation is to determine, if possible, the cause of a hearing loss. It also may rule out any medical problems which could accompany a hearing loss. This evaluation involves a full family medical history, a physical exam of the child, a review of birth and delivery records, and, possibly, hearing tests for other family members. Based on findings of this evaluation, other tests may be recommended.
Ophthalmology - Some children may have visual problems in addition to their hearing loss, and an examination by an ophthalmologist (eye doctor) is often recommended. Children with hearing loss may rely more on visual cues than children with normal hearing, so vision tests are critical for detecting problems and providing needed corrections.
Communication and Developmental Evaluations
Because hearing loss affects speech and language development and can affect academic performance, communication skills should be evaluated by a speech/language pathologist or an audiologist who is knowledgeable in the speech and language development of hearing-impaired children. Developmental skills and academic performance may be evaluated by a psychologist or a developmental specialist; this provides information about a child's ability to learn. All this information will be useful in developing an educational or family service plan.
Other referrals could be made based on results from these evaluations. These might include neurology, physical therapy, occupational therapy or social work. If you have questions or concerns, or would like additional information about any of the evaluations described here, ask your audiologist or physician.