Hearing Tests for Children

What are hearing tests for children?

These tests measure how well your child is able to hear. Although hearing loss can occur at any age, hearing problems in infancy and early childhood can have serious consequences. That's because normal hearing is essential for language development in babies and toddlers. Even a temporary hearing loss can make it harder for a child to understand spoken language and learn to speak.

Normal hearing happens when sound waves travel into your ear, causing your eardrum to vibrate. The vibration moves the waves farther into the ear, where it triggers nerve cells to send sound information to your brain. This information is translated into the sounds you hear.

Hearing loss happens when there is a problem with one or more parts of the ear, the nerves inside the ear, or the part of the brain that controls hearing. There are three main types of hearing loss:

• Conductive. This type of hearing loss is caused by a blockage of sound transmission into the ear. It's most common in infants and young children and is often caused by ear infections or fluid in the ears. Conductive hearing loss is usually mild, temporary, and treatable.
• Sensorineurual (also called nerve deafness). This type of hearing loss is caused by a problem with the structure of the ear and/or with the nerves that control hearing. It may be present at birth or show up late in life. Sensorineural hearing loss is usually permanent. This type of hearing loss ranges from mild (the inability to hear certain sounds) to profound (the inability to hear any sounds).
• Mixed, a combination of both conductive and sensorineural hearing loss.

If your child is diagnosed with hearing loss, there are steps you can take that may help treat or manage the condition.
Other names: audiometry; audiography, audiogram, sound test

What are they used for?

These tests are used to find out if your child has hearing loss and, if so, how serious it is.

Why does my child need a hearing test?

Routine hearing tests are recommended for most babies and children. Newborns are usually given hearing tests before they leave the hospital. If your baby doesn't pass this hearing test, it doesn't always mean serious hearing loss. But your baby should be retested within three months.

Most children should get their hearing checked at regular health checkups. These checkups may include a physical exam of the ear that checks for excess wax, fluid, or signs of infection. The American Academy of Pediatrics recommends more thorough hearing tests (see below for types of tests) at ages 4, 5, 6, 8, and 10. Tests should be done more often if your child has symptoms of hearing loss.

Symptoms of hearing loss in a baby include:

• Not jumping or being startled in reaction to loud noises
• Not reacting to a parent's voice by 3 months of age
• Not turning his or her eyes or head toward a sound by 6 months of age
• Not imitating sounds or saying a few simple words by 12 months of age

Symptoms of hearing loss in a toddler include:

• Delayed speech or speech that is hard to understand. Most young children can say a few words, like "mama" or "dada," by 15 months of age.
• Not responding when called by name
• Not paying attention

Symptoms of hearing loss in older children and teens include:

• Trouble understanding what other people are saying, especially in a noisy environment
• Trouble hearing high-pitched sounds
• Needing to turn up the volume on the TV or music player
• A ringing sound in the ears

What happens during a hearing test?

Initial hearing tests are often done during regular checkups. If there is hearing loss, your child may be tested and treated by one of the following providers:

• An audiologist, a health care provider who specializes in diagnosing, treating, and managing hearing loss
• An otolaryngologist (ENT), a doctor specializing in treating diseases and conditions of the ears, nose, and throat.

There are several types of hearing tests. The type of tests given depends on age and symptoms. For infants and young children, testing involves using sensors (which look like small stickers) or probes to measure hearing. They don't require a verbal response. Older children may be given sound tests.

Sound tests check for response to tones or words delivered at different pitches, volumes, and/or noise environments.

Auditory brainstorm (ABR) test.. This checks for sensorineural hearing loss. It measures how the brain responds to sound. It is most often used to test infants, including newborns. During this test:

• The audiologist or other provider will place electrodes on the scalp and behind each ear. The electrodes are connected to a computer.
• Tiny earphones will be placed inside the ears.
• Clicks and tones will be sent to the earphones.
• The electrodes measure the brain's response to the sounds and will display the results on the computer.

Otoacoustic emissions (OAE) test. This test is used for infants and young children. During the test:

• The audiologist or other provider will place a small probe that looks like an earphone inside the ear canal.
• Sound will be sent to the probe.
• The probe records and measures the inner ear's response to the sounds.
• The test can find hearing loss, but can't tell the difference between conductive and sensorineural hearing loss.

Tympanometry tests how well your eardrum moves. During the test:

• The audiologist or other provider will place a small device inside the ear canal.
• The device will push air into the ear, making the eardrum move back and forth.
• A machine records the movement on graphs called tympanograms.
• The test helps find out if there is an ear infection or other problems such as fluid or wax buildup, or a hole or tear in the eardrum.
• This test requires your child to sit very still, so it's not usually used on infants or young children.

The following are other types of sound tests:

Acoustic Reflex Measures also called middle ear muscle reflex (MEMR), test how well the ear responds to loud sounds. In normal hearing, a tiny muscle inside the ear tightens when you hear loud noises. This is called the acoustic reflex. It happens without you knowing it. During the test:

• The audiologist or other provider will place a soft rubber tip inside the ear.
• A series of loud sounds will be sent through the tips and recorded onto a machine.
• The machine will show when or if the sound has triggered a reflex.
• If hearing loss is bad, the sound may have to be very loud to trigger a reflex, or it may not trigger the reflex at all.

Pure-tone test, also known as audiometry. During this test:

• Your child will put on headphones.
• A series of tones will be sent to the headphones.
• The audiologist or other provider will change the pitch and loudness of the tones at different points during the test. At some points, the tones may be barely audible.
• The provider will ask your child to respond whenever they hear the tones. The response may be to raise a hand or press a button.
• The test helps find the quietest sounds your child can hear at different pitches.

Tuning fork tests. A tuning fork is a two-pronged metal device that makes a tone when it vibrates. During the test:

• The audiologist or other provider will place the tuning fork behind the ear or on top of the head.
• The provider will hit the fork so that it makes a tone.
• Your child will be asked to tell the provider whenever you hear the tone at different volumes, or if they heard the sound in the left ear, right ear, or both equally.
• The test can show if there is hearing loss in one or both ears. It can also show which type of hearing loss your child has (conductive or sensorineural).

Speech and word recognition  can show how well your child can hear spoken language. During the test:

• Your child will put on headphones.
• The audiologist will talk through the headphones, and ask your child to repeat a series of simple words, spoken at different volumes.
• The provider will record the softest speech your child is able to hear.
• Some of the testing may be done in a noisy environment, because many people with hearing loss have trouble understanding speech in loud places.
• These tests are done on children old enough to talk and understand language.

Will I need to do anything to prepare for a hearing test?

Your child doesn't need any special preparations for a hearing test.

Are there any risks to hearing tests?

There is no risk to having a hearing test.

What do the results mean?

Your results may show if your child has hearing loss, and whether the hearing loss is conductive or sensorineural.

If your child is diagnosed with conductive hearing loss, your provider may recommend medicine or surgery, depending on the cause of the loss.

If your child is diagnosed with sensorineural hearing loss, your results may show that the hearing loss is:

• Mild: your child can't hear certain sounds, such as tones that are too high or too low.
• Moderate: your child can't hear many sounds, such as speech in a noisy environment.
• Severe: your child can't hear most sounds.
• Profound: your child can't hear any sounds.

Treatment and management of sensorineural hearing loss will depend on age and how serious it is. If you have questions about the results, talk to your child's health care provider.

Is there anything else I need to know about hearing tests?

There are many ways to manage hearing loss. Even if the hearing loss is permanent, there are ways to manage your condition. Treatment options include:

• Hearing aids. A hearing aid is a device that's worn either behind or inside the ear. A hearing aid amplifies (makes louder) sound. Some hearing aids have more advanced functions. Your audiologist can recommend the best option for you.
• Cochlear implants. This is a device that's implanted surgically in the ear. It's usually used in people with more severe hearing loss and who don't get much benefit from using a hearing aid. Cochlear implants send sound directly to the hearing nerve.
• Surgery. Some types of hearing loss can be treated with surgery. These include problems with the eardrum or in the tiny bones inside the ear.

In addition, you may want to:

• Work with health care providers who can help you and your child communicate. These may include speech therapists and/or specialists who provide training in sign language, lip reading, or other types of language approaches.
• Join support groups
• Schedule regular visits with an audiologist and/or otolaryngologist (ear, nose, and throat doctor)

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