Audiometry: Methods of Screening Infant Hearing

Methods of screening infant hearing
An infant’s hearing is usually ‘screened’ by one or both of the following

methods:
 Auditory Brainstem Response (ABR) test, or
 Oto Acoustic Emission (OAE) test.
Both tests are effective and accurate. Importantly, neither test requires an
invasive procedure or even an observable response from the infant. The two
tests differ in the way they measure hearing.
The OtoAcoustic Emission (OAE) Test
In this test, a small microphone and speaker device is fitted into the infant’s
ear. A sound is played into the speaker and the test measures the response
that is produced by the cochlea (in the inner ear: see our page on Hearing
Loss: The Facts ).
Throughout, the infant is resting quietly undisturbed. As we know, in the

human body, sound is passed from the cochlea by an electrical stimulus into
the brain. But there is also a second sound that does not travel to the brain
at all but bounces back out into the ear canal. This is called an otoacoustic
emission. The microphone in the infant’s ear records this secondary sound
that has been bounced back into the ear canal and this recording is then
analyzed by the audiologist on a computer. Essentially, the audiologist sees
which sound has generated an emission and how strong that emission is.
Some sounds are essential to understanding speech. If those sounds yield an
emission, the infant has passed the test.
The Auditory Brainstem Response (ABR) Test
This test measures the brain’s response to a sound stimulus. In this test, the
infant is fitted with a pair of small earphones and several electrodes on its
Audiometry
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/003341.htm

methods:
Loss: The Facts ).

An audiometry exam tests your ability to hear sounds. Sounds vary based on their loudness
(intensity) and the speed of sound wave vibrations (tone).
Hearing occurs when sound waves stimulates the nerves of the inner ear. Eventually the sound
travels along nerve pathways to the brain.

methods:
Loss: The Facts ).

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The INTENSITY of sound is measured in decibels (dB):
 A whisper is about 20 dB
 Loud music (some concerts) is around 80 - 120 dB
 A jet engine is about 140 - 180 dB

methods:
Loss: The Facts ).

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The TONE of sound is measured in cycles per second (cps) or Hertz:
 Low bass tones range around 50 - 60 Hz

 Shrill, high-pitched tones range around 10,000 Hz or higher

methods:
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50,000 Hz. Human speech is usually 500 - 3,000 Hz.
How the Test is Performed

The first steps are to see whether you need an audiogram. The specific procedures may vary, but
they generally involve blocking one ear at a time and checking your ability to hear whispers,
spoken words, or the sound of a ticking watch.

methods:
Loss: The Facts ).

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its
head
to test the ability to hear by air conduction. It is tapped and placed against the mastoid bone
behind each ear to test bone conduction.
Audiometry provides a more precise measurement of hearing. To test air conduction, you wear
earphones attached to the audiometer. Pure tones of controlled intensity are delivered to one ear
at a time. You are asked to raise a hand, press a button, or otherwise indicate when you hear a
sound.

methods:
Loss: The Facts ).

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e v e r a l An
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conduction.
How to Prepare for the Test

No special preparation is needed.

methods:
Loss: The Facts ).

How the Test Will Feel
There is no discomfort. The length of time varies. An initial screening may take about 5 to 10
minutes. Detailed audiometry may take about 1 hour.
Why the Test is Performed


methods:
Loss: The Facts ).

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Common causes of hearing loss include:
 Acoustic trauma
 Chronic ear infections
 Diseases of the inner ear
 Head injury

methods:
Loss: The Facts ).

i n f an t Inherited
i s f i t t e dconditions
with a pair of small earphones and several electrodes on its
 Medications that can harm the inner ear, including certain antibiotics (such as neomycin
or gentamycin), diuretics, and large doses of salicylates (such as aspirin)
 Occupational hearing loss
 Ruptured eardrum
Normal Results
 The ability to hear a whisper, normal speech, and a ticking watch is normal.

methods:
Loss: The Facts ).

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everal electrodes on its
 In detailed audiometry, hearing is normal if you can hear tones from 250 Hz - 8,000 Hz at
25 dB or lower.
What Abnormal Results Mean

There are many different kinds and degrees of hearing loss. In some types, you only lose the
ability to hear high or low tones, or you lose only air or bone conduction. The inability to hear
pure tones below 25 dB indicates some hearing loss.

methods:
Loss: The Facts ).

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The following conditions may affect test results:
 Acoustic neuroma
 Acoustic trauma
 Age-related hearing loss
 Alport syndrome
 Labyrinthitis

methods:
Loss: The Facts ).

i n f an t Meniere's
i s f i t t e d disease
with a pair of small earphones and several electrodes on its
 Occupational hearing loss
 Otosclerosis
 Ruptured or perforated eardrum
Risks
There is no risk.

methods:
Loss: The Facts ).

Considerations
There are many different hearing function tests. In simple screenings, the health care provider
will make a loud noise and watch to see if it startles you. Detailed screenings include brainstem
auditory evoked response testing (BAER). This test uses an electroencephalogram to detect brain
wave activity when sounds are made.
Another hearing test called otoacoustic emission testing (OAE) can be used in very young
children (such as newborns) or when standard tests do not produce reliable results.

methods:
Loss: The Facts ).

Introduction
Pure-tone audiometry is a behavioral test used to measure hearing sensitivity. This measure involves the
peripheral and central auditory systems. Pure-tone thresholds (PTTs) indicate the softest sound audible to an
individual at least 50% of the time. Hearing sensitivity is plotted on an audiogram, which is a graph displaying
intensity as a function of frequency.

methods:
Loss: The Facts ).

Degrees of hearing loss
 Normal hearing (0-25 dB): At this level, hearing is within normal limits.
 Mild hearing loss (26-40 dB): Mild hearing loss may cause inattention, difficulty suppressing
background noise, and increased listening efforts. Patients with this degree of loss may not hear soft
speech. Children may be fatigued after listening for long periods.
 Moderate hearing loss (41-55 dB): Moderate hearing loss may affect language development, syntax
and articulation, interaction with peers, and self-esteem. Patients with this degree of loss have trouble
hearing some conversational speech.

methods:
Loss: The Facts ).

i n f an t Moderate-severe
i s f i t t e d w i t hhearing
a p a loss
i r o(56-70
f s m adB):
l l eModerate-severe
a r p h o n e s a n hearing
d s e v eloss
r a lmay
e l ecause
c t r o ddifficulty
e s o n with
its
speech and decreased speech intelligibility. Patients with this degree of loss do not hear most
conversational-level speech.
 Severe hearing loss (71-90 dB): Severe hearing loss may affect voice quality.
 Profound hearing loss (>90 dB): With profound hearing loss (deafness), speech and language
deteriorate.
Types of hearing loss
 Conductive

methods:
Loss: The Facts ).

i n f a n t i s foi t t e d w i t h ahearing
Conductive p a i r loss
o f shas
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l l e a rbone-conduction
p h o n e s a n d thresholds,
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ctrodes on its
thresholds are poorer than normal by at least 10 dB.
o Conductive hearing loss is secondary to an outer ear or middle ear abnormality, which can
include abnormalities of the tympanic membrane. The abnormality reduces the effective
intensity of the air-conducted signal reaching the cochlea, but it does not affect the bone-
conducted signal that does not pass through the outer or middle ear.
o Examples of abnormalities include occlusion of the external auditory canal by cerumen or a
mass, middle ear infection and/or fluid, perforation of the tympanic membrane, or ossicular
abnormalities. Pure-tone air-conduction thresholds are poorer than bone-conduction
thresholds by more than 10 dB (see image below).

methods:
Loss: The Facts ).

i n f a n t i s foi t t e d w i t h a p a i r o f s m a l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s

methods:
Loss: The Facts ).


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Loss: The Facts ).

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w i t h a p adepicting
ir of smaa lmild
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p h o n conductive
e s a n d s e vhearing
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its
Note the significant air-bone gaps.

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Loss: The Facts ).


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Loss: The Facts ).

i n f an t Sensorineural
is fitted with a pair of small earphones and several electrodes on its
o Sensorineural hearing loss has bone- and air-conduction thresholds within 10 dB of each
other, and thresholds are higher than 25 dB HL. See image below.
o

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Loss: The Facts ).


methods:
Loss: The Facts ).

ir of smaa lhigh-frequency
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e s o n iloss
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methods:
Loss: The Facts ).


methods:
Loss: The Facts ).

i n f a n t i s foi t t e d w i t h a phearing
Sensorineural a i r o floss
s misasecondary
l l e a r p h to
o ncochlear
e s a n dabnormalities
s e v e r a l eand/or
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o dabnormality
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the auditory nerve or central auditory pathways. Because, in this type of hearing loss, the
outer ear and middle ear do not reduce the signal intensity of the air-conducted signal, both
air- and bone-conducted signals are effective in stimulating the cochlea. Pure-tone air- and
bone-conduction thresholds are within 10 dB.
o Examples included presbycusis, noise-induced hearing loss, Ménière disease, and
retrocochlear lesions such as vestibular schwannoma.
 Mixed
o Mixed hearing loss has conductive and sensorineural components.

methods:
Loss: The Facts ).

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This i t hofahearing
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components. o d e s o nair-i t s
conduction thresholds are poorer than bone-conduction thresholds by more than 10 dB, and
bone-conduction thresholds are less than 25 dB (see image below).
o

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Loss: The Facts ).


methods:
Loss: The Facts ).

ir of smaa lmixed
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Loss: The Facts ).


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Loss: The Facts ).

Terminology
 Audiogram
o The audiogram is a chart of hearing sensitivity with frequency charted on the abscissa and
intensity on the ordinate (see images shown above). Intensity is the level of sound power
measured in decibels; loudness is the perceptual correlate of intensity.
o For threshold testing intensity, decibels are measured in hearing level (HL), which is based on
the standardized average of individuals with normal hearing sensitivity. HL is not equivalent to
sound pressure level (SPL), but the American National Standards Institute (ANSI) has defined
a relationship between SPL and HL for each audiometric frequency from 250-8000 Hz.

methods:
Loss: The Facts ).

i n f an t Frequency
is fitted with a pair of small earphones and several electrodes on its
o Frequency is cycles per unit of time. Pitch is the perceptual correlate of frequency. Frequency
is measured in hertz, which are cycles per second.
o Usually frequencies of 250-8000 Hz are used in testing because this range represents most of
the speech spectrum, although the human ear can detect frequencies from 20-20,000 Hz.
Some children can detect even higher frequencies.
 Pure-tone average
o Pure-tone average (PTA) is the average of hearing sensitivity at 500, 1000, and 2000. This
average should approximate the speech reception threshold (SRT), within 5 dB, and the
speech detection threshold (SDT), within 6-8 dB.

methods:
Loss: The Facts ).

i n f a n t i s foi t t e
If dthewSRT
i t h isa significantly
p a i r o f sbetter
m a l l than
e a rthe
p hPTA,
o n e sthea possibility
n d s e v eof
r apseudohypoacusis
l e l e c t r o d e s oshould
n i t s be
considered. If the PTA is significantly better than the SRT, the possibility of central
involvement should be considered.
 Speech reception threshold
o The SRT is the softest intensity spondee words that an individual can repeat at least 50% of
the time.
o Spondees are bisyllabic words equally emphasizing both syllables. In some cases (eg,
patients with poor word recognition), a limited set of words may be used.
 Speech detection threshold

methods:
Loss: The Facts ).

i n f a n t i s foi t t e d w
The i t h adetection
speech p a i r o threshold
f s m a l l (SDT),
earph o n termed
also es and thesspeech
e v e r a awareness
l e l e c t r othreshold
d e s o n (SAT),
i t s is
the lowest intensity speech stimulus that an individual can detect at least 50% of the time.
 Word recognition
o Word recognition (formerly called speech discrimination) is the ability to repeat correctly an
open set of monosyllabic words at suprathreshold intensity. Word lists are phonetically
balanced (PB), meaning that the speech sounds used occur with the same frequency as in
the whole language.
o The score represents the percent of words correct for most word recognition tests.
Common audiogram/audiologic assessment abbreviations


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Loss: The Facts ).

i n f an t CNT
i s f i- tCould
ted w i t test
not h a pair of small earphones and several electrodes on its
 DNT - Did not test
 HA - Hearing aid
 HAE - Hearing aid evaluation
 NR - No response
 SNHL - Sensorineural hearing loss
 WNL - Within normal limits
 AU - Both sides (ears)
 AS - Left
 AD - Right

methods:
Loss: The Facts ).

i n f an t VT
i s -fVibrotactile
i t t e d w i tresponse
h a pair of small earphones and several electrodes on its
 RTC - Return to clinic
 PRN - As needed
 BC - Bone conduction
 AC - Air conduction
 PTA - Pure-tone average
 UCL - Uncomfortable loudness level
 MCL - Most comfortable loudness level
 HFA - High frequency average
 HL - Hearing level

methods:
Loss: The Facts ).

i n f an t SPL
i s f-i tSound
ted w ith a p
pressure air of small earphones and several electrodes on its
level
 SRT - Speech reception threshold
 SAT - Speech awareness threshold
Indications
 The usual primary purpose of pure-tone tests is to determine the type, degree, and configuration of
hearing loss.

methods:
Loss: The Facts ).

Contraindications
 Patients unable to cooperate because of young age or other conditions cannot undergo pure tone
audiometry. They may need to have the auditory system tested by other methods.

methods:
Loss: The Facts ).

iAudiology
n f a n t i s f(from
i t t e d Latin
w i t h audīre,
a p a i r"to
o fhear";
s m a land
l e afrom
r p h oGreek
n e s a-λογία,
n d s e v-logia)
e r a l eis
l ethe
c t rbranch
o d e s oof
n science
its
that studies hearing, balance, and related disorders. Its practitioners, who treat those with hearing
loss and proactively prevent related damage are audiologists. Employing various testing
strategies (e.g. hearing tests, otoacoustic emission measurements, videonystagmography, and
electrophysiologic tests), audiology aims to determine whether someone can hear within the
normal range, and if not, which portions of hearing (high, middle, or low frequencies) are
affected and to what degree. If an audiologist determines that a hearing loss or vestibular
abnormality is present he or she will provide recommendations to a patient as to what options
(e.g. hearing aid, cochlear implants, surgery, appropriate medical referrals) may be of assistance.

methods:
Loss: The Facts ).

iAudiology
n f a n t i s fisi tat ebranch
d w i t hof ascience
p a i r owhich
f s m adeals
l l e awith
r p h othe
n estudy
s a n dofshearing,
e v e r a l balance
e l e c t r oand
d e srelated
on its
disorders through tests and treatment through hearing aids.
In addition to testing hearing, audiologists can also work with a wide range of clientele in
rehabilitation (cochlear implants and/or hearing aids), pediatric populations and assessment of
the vestibular system.
What are OAEs?


methods:
Loss: The Facts ).

Otoacoustic emissions are sounds made by our inner ear as it works to extract the information from sound to pass on
to the brain. These biological sounds are a natural by-product of this energetic biological process and their existence
provides us with a valuable ‘window’ on the mechanism of hearing, allowing us to detect the first signs of deafness -
even in newborn babies.

methods:
Loss: The Facts ).


methods:
Loss: The Facts ).

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Sounds i s f iby
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n d usually
s e v e less
r a l than
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30dBSPL. o n arrive
i t s in
the ear canal because the middle ear receives vibrations from deep inside the cochlea. This causes the eardrum to
vibrate the air in the ear canal creating the sounds that we can record.
To record otoacoustic emissions, or ‘OAEs’, a ‘probe’ is inserted in the ear canal. The probe closes the ear canal,
keeping the OAEs in and any noise out. The probe both stimulates the ear with precisely defined sounds and records
the sounds made by the ear via a tiny microphone.
Separating the applied sound from the ear’s own sound is a delicate business and needs computer processing
power.

methods:
Loss: The Facts ).

i n f a nthis
Today t i sis achieved
fitted w byi tahvariety
a p aofi rotoacoustic
o f s m a linstruments.
l e a r p h oHand-held
n e s a n dand
s epocket-sized
v e r a l e l escreeners
c t r o d e sare
o navailable
its
which provide a quick indication of the status of the ear and are widely used for infant screening. Because OAEs are
blocked by middle ear immobility, these instruments alert to both conductive and sensory dysfunction. Some OAE
screeners provide a single indicator of function across speech frequencies, as does screening ABR. Others provide a
basic frequency breakdown. Although OAE screeners are sensitive to threshold elevations as small as 20dB, they do
not provide a measure of the actual threshold.
Simple OAE screening instruments conceal the fact that otoacoustic emissions are quite complex phenomena -
whether they are evoked by tones or clicks. Click evoked OAEs (TEOAEs) consist of a complex response waveform
which can be broken down into different frequency bands (typically half octave), telling us about cochlear status in
each band. Distortion product OAEs are evoked by a pair of tones (typically one-third-octave apart) which are

methods:
Loss: The Facts ).

i n f a n t across
stepped i s f i tthe
ted with a
frequency p a ito
range r be
o fexamined.
s m a l l eEach
a r p pair
h o nofetones
s a nmay
d se v e r a lseveral
produce e l e c tDPOAEs.
r o d e s oOne
n iof
t sthese
(typically the one at 2f1-f1) is plotted on the ‘DP gram’.
Both TEOAEs and DPOAEs provide frequency specific data on cochlear function.
HOW WE HEAR

methods:
tests differ in the way they measure hearing. Ear Care
The OtoAcoustic Emission (OAE) Test Do not

clean your
ears or
your
e a r . A s o u n d i s p l a y e d i n t o t h e s p e a k e r a n d t h e t e s t m e a s u r e s t h e r echild’s sponse
t h a t i s p r o d u c e d b y t h e c o c h l e a ( i n t h e i n n e r e a r : s e e o u r p a g e o n H eears arin g
with
Loss: The Facts ). cotton
buds, pins,
T h r o u g h o u t , t h e i n f a n t i s r e s t i n g q u i e t l y u n d i s t u r b e d . A s w e k n o w , i netc.
theSee
your
doctor.
 Keep
water out.
emission. The microphone in the infant’s ear records this secondary sUse
o u near
d
that has been bounced back into the ear canal and this recording is tplugs
hen
a n a l y z e d b y t h e a u d i o l o g i s t o n a c o m p u t e r . E s s e n t i a l l y , t h e a u d i o lo g iSee
s t syour
ees
w h i c h s o u n d h a s g e n e r a t e d a n e m i s s i o n a n d h o w s t r o n g t h a t e m i s s i o ndoctor
is. if
Some sounds are essential to understanding speech. If those
your ear’s
sounds yield an
or your
child’s ear
hurt.
 Do not put
oil in your
T h i s t e s t m e a s u r e s t h e b r a i n ’ s r e s p o n s e t o a s o u n d s t i m u l u s . I n t h i s ears t e s tor
, the
T
i nhfea neta irs i sf i tdtievdi dw
edi t hi nat op tahi rr eoef p
sma rat s
l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s your
on its
child’s
 the outer ear ears.
 the middle ear and  Do not
bottle feed
 the inner ear your child.
 Do not
The Outer Ear includes the visible parts, the pinna and the
expose
ear canal. yourself or
your child
to loud
sounds (eg
firecracker
s)

methods:
Loss: The Facts ).

T
i nhfea nM
t iidsdfliet t e
Eda rwci tohn sai sptas i ro fo ft hsemeaal lr deraurm
p ha
on d
e st harnede stei n
vye rbaol neel es c: t trh
oed ehsa o
mnmiet sr -
anvil-stirrup or, in technical terms, the malleus, incus and stapes.
The Inner Ear includes the cochlea, semi-circular canals and the hearing
nerve.
As we know, sound travels in waves. Normally, these sound waves are picked
up by the outer ear, conducted into the ear canal where they strike the

methods:
Loss: The Facts ).

e
i nafradnrtu m
i s (f iatltseod cwailtl h
e da t p
hae i rt yom
f psamnai cl l m
e aerm
pbhroannees) .a nTdh i s em
v earkael setl e
h cet reoadr e
d sr uomn ai tnsd
three bones in the middle ear to vibrate. The vibration of these three bones
agitates or moves the cochlear fluid in the inner ear. This in turn makes hair
cells in the cochlea bend. These hair cells convert the mechanical energy of
their bending movements into tiny electrical pulses which are then sent down
the auditory nerve and on to a specific region of the brain which decodes
them first into sound and then into intelligible or recognizable sound.

methods:
Loss: The Facts ).

O
i nff acnotu ri s ef,i tttheed hwui tmhaa
n pbaoidr yo b
f esim
n ga l tl heea rm
pahrovneel so uasn d
pie
sece
v eor fa le n
e lgei cntereordi e
n sg ot h
n aitt si t
is, all this hearing activity happens incredibly quickly—down to the ‘decoding’
so that we can distinguish a voice from an engine roar, a male voice from a
female, and even different types of voices, accents, pronunciations.
DIFFERENT TYPES OF HEARING LOSS
There are three different types of hearing loss:


methods:
Loss: The Facts ).

 i n f a n t Ci so nf d
i tut e
c tdi vwei tHhe a rpi nagi r Loofs s m
—ao lul t e a
r /r m
p hi d
odnlees eaanrddsaemv a
egr ael; e l e c t r o d e s o n i t s
 Sensori-neural Hearing Loss—inner ear damage, outer and middle ears

all right;
 Mixed Hearing Loss—damage to outer/middle and inner ear structures
Conductive Hearing Loss may result from obstructions or abnormalities in or

damage to the outer or middle ears. Impacted wax, a perforated eardrum,
fluid in the middle ear, may all cause conductive hearing loss.

methods:
Loss: The Facts ).

S
i nefn
a snot riis- nfei tutreadl w
H ietahr ian gp aLior sosf oscm
cua rl ls ewah
rpeh
n otnhees i a
nnnd
e rs e a
ver rias l deal e
mcat g
r oeddeo
s ro n i t s
obstructed, but the outer and middle ear structures are otherwise all right.
Damaged or dead hair cells in the cochlea, a missing or deformed cochlea,
etc, typically cause this kind of hearing loss.
Mixed Hearing Loss_is a result of damage to the outer/middle ear structures

_and _also to the inner ear. This is, thus, a combination of the previous two.

methods:
Loss: The Facts ).

E
i nxfaam
n tp li e
s sf iitntceldu dwei tw
h aax pi n
a i rt hoef csamnaalll _eaanr p
d hdoanm
e sa gaendd hsaeivr ecr e
a l l se lienc ttrhoed e
cos cohnl eiat ;s
fluid in the middle ear and dead hair cells within the cochlea, etc.
TREATMENT AND PROCEDURES
It may be possible to treat a conductive hearing loss with surgical or medical

procedures. Similarly, in cases of a mixed hearing loss, outer/middle ear
damage may be amenable to treatment.

methods:
Loss: The Facts ).

T
i nhfea notn il sy foi tpttei o
dnwfiot h
r sae n
psao
i rr io- fn esu
mraalll heeaarrpih
nognleoss sa,n h
d osweevveer ra,l iesl eacptpr o
r odpersi aotne i t s
amplification: hearing aids or cochlear implants.
CAUSES /HIGH RISK FACTORS FOR HEARING LOSS
 Family history of hearing loss
 Rh incompatibility
 Hyperbilirubinemia

methods:
Loss: The Facts ).

 infant M
i se nf iitntgeidt i sw i t h a p a i r o f s m a l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
 Septicemia
 Head Trauma
 Infectious diseases or illness during pregnancy (rubella, syphilis, etc.)
 Alcohol/nicotine intake by the mother during pregnancy
 Ototoxic drugs
 Exposure to X-rays

methods:
Loss: The Facts ).

 i n f a n t Di si f f i ct tuel tdy wbirtehaat hpi nagi r aotf bsim
r tahl l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
 Mechanical ventilation at birth
 Low APGAR score, no birth cry
 Admission into NICU
 Premature birth and Low Birth Weight
 Abnormalities of the Head/Neck/Face


methods:
Loss: The Facts ).

 i n f a n t Ci sh ifl idtrt e n
d with n
a epuar ior- d
oef gsemnaelrl aet iavrep hdoi sneeass a
ens /do s
thee
v re rsayl nedlreocm
t reosd eksn oow
n ni ttso
include a Sensori-neural or Conductive hearing loss.
 Genetic disorders
 Consanguinity
FACTORS AFFECTING OPTIMAL USE OF RESIDUAL HEARING
 Age at onset of deafness


methods:
Loss: The Facts ).

i n f an t Di su rfai ttti e
odn w
o fi t d
h eaa fpnaeisrs o f s m a l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
 Age at providing appropriate amplification (hearing aids/cochlear

implants)
 Consistent use of functioning amplification devices
 Listening environment at home
 Educational program

methods:
Loss: The Facts ).

R
i nEf C
aOnM i sE Nf iDt ItNeGd A
t M wMi tPhL IaF IpCaAiTr I O
oNf sI m e EaSr pThHoEn eFsA M
N VaOl lL V anI LdY sA
eN e r—a l e l e c t r o d e s o n i t s
vD
 an ENT surgeon
 an audiologist
 a teacher for the hearing-impaired, and, possibly
 a social worker/counselor and
 a psychologist

methods:
Loss: The Facts ).

i n fHaYn tI S i sE Af iRt Lt e
W Y dI DwEiN F I CpAaTi rI OoNf IsM
t hT I a mPaOl R p ?h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
l TeAaNr T
If the auditory channel is impaired or blocked, speech and language may not
develop properly. Since the first three years of life are critical for normal
speech and language development, every effort should be made to identify
hearing impairment during these early listening years.

methods:
Loss: The Facts ).

Ii ndfeanntti f i sc afti itot e
n do w
f iht e
haar i npga i lro o
ssf si n
mai nl lf aenatrsp h
aonn
d ecsh a
i lnddr esne v
req
rauli reelse cctarroedfeusl o n i t s
observation, a thorough medical examination with an extensive case history,
and an audiological evaluation. Help identify young children who may need a
medical and/or audiological evaluation by familiarizing yourself with the
facts.
WHEN AND HOW TO EVALUATE


methods:
Loss: The Facts ).

Ii nf fsapnet eicsh f iat n
t edd l awni g
t hu aag e
p adi re voef l o
smpm
a lel net abr e
pgh ionnse n
s oarnmda s
l leyv a
enr adl tehl e n
c t rs o
t odpess, orne fiet rs
immediately for a hearing evaluation. A child of any age can have an
audiological evaluation. The evaluation technique used depends upon the
developmental age of the infant or child. Methods include Auditory Brainstem
Response (ABR) and Oto Acoustic Emission (OAE) testing at any age
(including premature infants), and Visual Response Audiometry (VRA), which
is designed to elicit consistent and reliable responses from only a few months
of age. Play Audiometry is used at around 2 1/2 years of age until the child is

methods:
Loss: The Facts ).

a
i nbflaen t oi sr ef si tpt o
end dwci o
t hn sai spt e
ani rt loyf tsomtahlel ecaornpvheonnt e
i osn a n
l de vsaelvueartai ol ne lteeccthr o
ndi qeuse o
s nu istesd
with adults. Our pediatric audiology team can help decide which method is
best for a child. In order to obtain complete and accurate test results,
children may need to be seen on more than one occasion.
Early identification and assessment are the first steps in the successful
management of the hearing impaired child.

methods:
Loss: The Facts ).

i nIfGaHn tRiIsS Kf i F
H t tAeCdT w
O Ri tSh a p a i r o f s m a l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
Birth - 28 days:
 Malformations of the ear, nose or throat
 Rubella during pregnancy
 Rh incompatibility

methods:
Loss: The Facts ).

i n f an t Fi a
smf iitl tye d
h i swtiot rhy ao p
f ahier aorfi nsgmlaolsl se a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
 Apgar score from 0 - 3
 Severe neonatal infections
 Meningitis
 Low birth weight (under 3.3 lbs.)
 Hyperbilirubinemia
 Ototoxic medications

methods:
Loss: The Facts ).

i n f an t Si se vf e
i trtee dr ew
spi tihr aat opray i rd iosft rsem
s sa l a
l neda/roprh opnr o
e lso n
agne
d ds e
mveecrhaal neilceaclt rvoednet si l aotni oint s( 1 0
days or more)
29 days - 2 years
 Parent/caregiver concern regarding hearing, speech, language and/or

developmental delay
 Meningitis

methods:
Loss: The Facts ).

i n f an t Pi rs efsi e
t tnecde w
o ift h
n eao npaati a
r l orfi sskm faal lc teoarrsp h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s
 Head trauma
 Stigmata
 Ototoxic medications
 Neurodegenerative disorders
 Childhood infectious diseases associated with hearing loss (e.g. mumps,

measles)

methods:
Loss: The Facts ).

A
i n fcahni ltdi sw fhio hd
tte a swhi tahd ao npea i o
r ro m
f som
r ea lol f etahrepsheo n
ceo sn dai n
t ido nsse vi se rcaol nesliedcetrreodd e"sa to n
r i si k
t s"
for a hearing impairment and should have a comprehensive audiological
evaluation by a pediatric audiologist.
MILESTONES OF NORMAL DEVELOPMENT
Some babies have a significant hearing loss due to unknown factors. Use
these developmental guidelines to watch for hearing and speech milestones.

methods:
Loss: The Facts ).

0
i n f-a n
4t m
i so fni t thesd: w
S ittohp sa m
p aoivr eomf esnm
t aol rl e
qauri e
p thso n
i ne sr easnpdo ns seev etroa ls peel eeccthr.o d
Set a
s rot lne si t s
to
loud sounds. Moves eyes toward sound source. Arouses from light sleep to
sudden loud noises.
4 - 7 months: Begins head turn toward sounds and voices out of sight (4
months) and turns head directly toward the sound source (7 months). Smiles
in response to speech. Looks in response to own name. Babbling begins.

methods:
Loss: The Facts ).

7
i n f-a n
9t m
i so fni t thesd: w
Tui trhn sa tpoa ifri nodf as m
soau
l lneda sr p
ohuo
r cnee so uatn d
o f sseivgehrta. l Geul er g
c tl e
r os doers coono si t st o
sounds out of sight. Intonation patterns heard in speech. Comprehends "no."
Babbles in multiple syllables.
9 - 12 months: Acquires first true word. Imitates sounds. Looks at a common

object when named. Responds to music. Understands simple commands.

methods:
Loss: The Facts ).

1
i n3f a-n t1 8
is m
f i totn
e tdhw
s :i t U
h sae sp as ierno
t ef nscm
ea- l il keeairnpthoonnaet s
ioa
nn. dP esrecveei rvaels eel e
mcot tr ioodness oofno itthse r s .
Uses 3 - 20 words. Uses all vowels and consonants in jargon.
19 - 24 months: Uses more words than jargon. Asks question by rising

intonation at end of phrase. Comprehends about 300 words. Uses about 50
words. Produces animal sounds. Combines 2 words into phrases. Listens to
simple stories.

methods:
Loss: The Facts ).

i n f a n t i s f i t t e d w i t h a p a i r o f s m a l l e a r p h o n e s a n d s e v e r a l e l e c t r o d e s o n i t s

Audiometry: Methods of Screening Infant Hearing

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Audiometry: Methods of Screening Infant Hearing

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Methods of screening infant hearing

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

The INTENSITY of sound is measured in decibels (dB):

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

The TONE of sound is measured in cycles per second (cps) or Hertz:

 Low bass tones range around 50 - 60 Hz

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

How the Test is Performed

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

How to Prepare for the Test

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

Why the Test is Performed

An infant’s hearing is usually ‘screened’ by one or both of the following

 Auditory Brainstem Response (ABR) test, or

 Oto Acoustic Emission (OAE) test.

The OtoAcoustic Emission (OAE) Test

Throughout, the infant is resting quietly undisturbed. As we know, in the

The Auditory Brainstem Response (ABR) Test

Common causes of hearing loss include:

An infant’s hearing is usually ‘screened’ by one or both of the following