TABLE 5

Audiologic Tests for Infants and Children

Developmental Age of ChildAuditory Test/ Average TimeType of MeasurementTest ProceduresAdvantagesLimitations
All agesEvoked OAEs/10-min testPhysiologic 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 detectionEar-specific results; not dependent on whether patient is asleep or awake; quick test time; screening testInfant 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 moAutomated ABR/15-min testElectrophysiologic measurement of activity in auditory nerve and brainstem pathwaysPlacement of electrodes on child's head detects neurologic response to auditory stimuli presented through earphones or ear inserts 1 ear at a timeEar-specific results; responses not dependent on patient cooperation; screening testInfant 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 yVRA/15- to 30-min testBehavioral tests measuring responses of the child to speech and frequency-specific stimuli presented through speakers or insert earphonesTechnique 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 roomAssesses 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 yPlay audiometry/ 15–30 minBehavioral test of auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibratorChild is conditioned to respond when stimulus tone is heard, such as to put a peg in a pegboard or drop a block in a boxEar-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 adolescenceConventional audiometry/15- to 30-min testBehavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibratorPatient is instructed to raise his or her hand when stimulus is heardEar-specific results; assesses auditory perception of patient; screening or diagnostic testDepends on the level of understanding and cooperation of the child
All agesDiagnostic ABRElectrophysiologic measurement of activity in auditory nerve and brainstem pathwaysPlacement of electrodes on child's head detects auditory stimuli presented through insert earphones 1 ear at a timeEar-specific results; multiple frequencies are tested, creating a map of hearing loss similar to an audiogram; responses not dependent on patient cooperation; diagnostic testInfant 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 agesTympanometryRelative change in middle-ear compliance as air pressure is varied in the external auditory canalSmall probe placed in the ear canal and pressure varied in the ear canalTests for possible middle-ear pathology and pressure-equalization tube functionNot 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.