TABLE 3.

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 stimulusSmall 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 timeInfant or child must be relatively inactive during the test; not a true test of hearing, because it does not assess cortical processing of sound
Birth to 9 moAutomated ABR, 15-min testElectrophysiologic measurement of activity in auditory nerve and brainstem pathwaysPlacement of electrodes on child’s head detects auditory stimuli presented through earphones 1 ear at a timeEar-specific results; responses not dependent on patient cooperationInfant or child must remain quiet during the test; not a true test of hearing, because it does not assess cortical processing of sound
9 mo to 2.5 yCOR or VRA, 30-min testBehavioral tests measuring responses of the child to speech and frequency-specific stimuli presented through speakersBoth techniques condition the child to associate speech or frequency-specific sound with a reinforcement stimulus, such as a lighted toy; VRA requires a sound-treated roomAssesses auditory perception of childOnly assesses hearing of the better ear; not ear-specific; cannot rule out a unilateral hearing loss
2.5 y to 4 yPlay audiometry, 30-min testBehavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones and/or bone vibratorChild is conditioned to put a peg in a peg board or drop a block in a box when stimulus tone is heardEar-specific results; assesses auditory perception of childAttention span of child may limit the amount of information obtained
4 y to adolescenceConventional audiometry, 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 patientDepends on the level of understanding and cooperation of the child
  • Adapted with permission from Bachmann KR, Arvedson JC. Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998;19:155–165.