Children & Pediatric Audiology

Pediatric Audiology

Why should my child have a hearing test?

On January 1, 2008, California implemented the Universal Newborn Hearing Screening Legislation, which requires hospitals to provide hearing screenings to every newborn. If the baby does not pass the newborn hearing screening, he or she will be referred for further testing with a pediatric audiologist. All of our audiologists have received extensive training in pediatrics and are state-licensed and nationally certified. They perform these tests to determine if the baby has a hearing loss and if so, what degree (how much hearing loss) and type (what part of the auditory system is affected).

The younger a child is diagnosed with hearing loss and fit with amplification (hearing aids / cochlear implants) the better chances he or she has to learn language. Studies have shown that children that are amplified by 6 months of age can learn language similarly to their normal hearing peers.

Our goals for your child include:

  • Providing appropriate amplification by the age of 3 months of age
  • To see the child enrolled in early intervention programs before 6 months of age

I think my Child has hearing loss?

Coming Soon ...

>> Back to top

Why does my child have a hearing loss?

If your child has been diagnosed with a hearing loss, you may feel sad, shocked, a sense of loss and wonder what could have caused this? Our physicians will guide you through the appropriate steps in determining this cause. These tests may include:

  • CAT Scan
  • Genetic Testing
  • Kidney Test

In addition, your ENT may make the following referrals for further follow up:

  • Opthamologist
  • Optometrist

The above tests will be completed to check for possible causes for hearing loss, such as:

>> Back to top

How Do you Test for Hearing Loss in Children

We offer many types of hearing tests. When these tests are performed depend on the age of your baby, since some tests require certain developmental milestones (such as head turning) to be completed. Our tests include:

ABR

What is it?

The Auditory Brainstem Response (ABR) is a test used to determine hearing loss in children who are either too young to respond or are unable to respond. It tells us how loud a sound must be for your child to hear it. What it does not do is tell us is if your child understands what he or she hears. An ABR is performed while your baby sleeps. This test can be performed under sedation or during natural sleep.

How is it performed?

The audiologist will scrub the skin where four electrodes will be placed (forehead and behind the ears). After the electrodes are in place, you may hold your child until he or she falls asleep. Once your child is sleeping, the audiologist will place small ear phones into his or her ears that will make a clicking sound. This sound travels from your child’s ears to the brain (through the auditory pathway) where it is recorded through the electrodes.

You will know the results of the ABR on the same day as the testing. Your audiologist will explain the results as well as recommend follow up appointments, if needed and send her report to your ENT.

How long does it take?

Under natural sleep, your child will be scheduled for four hours for both the ABR and ASSR to be completed. Your audiologist may complete additional tests at this appointment, such as Immittance tests and otoacoustic emissions (links).

Important instructions

(include hand out provided to parents)

Assr

What is it?

Auditory Steady State Response (ASSR) is a test used to determine hearing loss in children who are either too young to respond or are unable to respond. Most children are referred for an ASSR after a newborn hearing screen in the hospital indicates the possibility of hearing loss. This test is typically performed at the same time as the ABR (Auditory Brainstem Response).

How is it performed?

The audiologist will scrub the skin where four electrodes will be placed (forehead and behind the ears). After the electrodes are in place, you may hold your child until he or she falls asleep. Once your child is sleeping, the audiologist will place small ear phones into his or her ears that will play tones of varying frequency (pitch) and intensity (loudness). This sound travels from your child’s ears to the brain (through the auditory pathway) where it is recorded through the electrodes. ASSR provides an accurate, frequency-specific estimate of the behavioral pure-tone audiogram.

The use of ASSR in estimating hearing loss in children was the subject of a study by Audiologists at California Ear Institute. The article “Estimation of Hearing Loss in Children: Comparison of Auditory Steady-State Response, Auditory Brainstem Response, and Behavioral Test Methods” was published in the American Journal of Audiology in December 2003.

How long does it take?

Under natural sleep, your child will be scheduled for four hours for both the ABR and ASSR to be completed. Your audiologist may complete additional tests at this appointment, such as Immittance tests and otoacoustic emissions (links).

Important instructions

(include parent take – home sheet)

Pediatric Hearing Testing

What is it?

These tests are performed in a sound proof room, called a sound booth. The goal of a pediatric hearing test is to obtain information regarding hearing levels from children who are unable to respond in the same manner that older children and adults respond. This is done in one of two ways depending on the age of the child. For infants and young toddlers, aged 5 months to about 2.5 years of age, Visual Reinforcement Audiometry (VRA) is used. Conditioned Play Audiometry (CPA) is used for children aged 2.5 - 4 years old.

How is it performed?

VRA: During VRA testing the child is seated on the parent's lap, in a high chair or seated alone. The child must be able to sit upright and turn their head from side to side. A test assistant is seated facing the child to keep their attention forward between auditory stimuli. VRA uses lighted and/or animated toys that are flashed on simultaneously with the presentation of an auditory signal (warble tones, narrow band noise or speech) during a conditioning period.

Once the child is conditioned, the toy is activated immediately after the child turns toward the signal. The auditory signal is presented either through speakers on the right or left side (sound field) or, if the child will accept them, through foam insert earphones. The softest level that the child responds to the auditory signal is recorded on the audiogram. Sound field testing provides information about the hearing level of only the better ear while insert earphone testing provides information about the hearing levels of each ear.

CPA: During Conditioned Play Audiometry the child is seated across from a test assistant and is instructed to place a toy in a bucket or game when a sound is heard either through insert ear phones or a sound speaker. Initial sounds are presented well above the child’s expected threshold to familiarize the child with the task. Once the child is conditioned and understands the task, progressively softer sounds are presented until the child’s threshold is found.

Depending on the age of the child and their willingness to repeat words, a speech reception threshold (SRT) or speech awareness threshold (SAT) may be obtained. A SRT is the softest level at which the child can understand speech. The child may be asked to point to body parts, objects or pictures or to repeat two syllable words to obtain an SRT. The SAT is the softest level of speech that the child can hear. The SAT may be obtained by having the child respond to soft speech in the same way they respond to the tones for either conditioned play or VRA.

How long does it take?

These appointments are scheduled for 45 minutes. In addition to VRA or CPA additional testing may be performed during this appointment, such as Immittance tests and otoacoustic emissions.

Important instructions

Since this test requires the child’s participation, it is best scheduled around naptime. Pick a time when you know your child is most attentive during the day. This may be after naptime or first thing in the morning.

Immittance Tests

What is it

This group of tests (tympanometry and acoustic reflexes) measure how well your child’s middle ear works. These tests are commonly performed as they are sensitive to middle ear disorders. These tests do not require the child to respond.

How is it performed

Tympanometry: An ear tip is placed in the canal that is connected to a machine that briefly varies the pressure in your child’s ear. Results from this test could indicate:

  • fluid in the middle ear (otitis media)
  • discontinuity of the ossicular chain (the three bones in the middle ear)
  • perforated eardrum
  • Eustachian tube dysfunction

Acoustic Reflex Thresholds: This test measures how much the stapedius muscle in the middle ear contracts in response to a loud sound. This muscle acts as a protective mechanism that dampens loud sounds before they reach the cochlear (hearing organ). Absence or presence of acoustic reflexes for various presentations may be important in the differential diagnosis of both peripheral and central disorders of the auditory system such as vestibular schwannoma or facial nerve disorders.

Otoacoustic Emissions

What is it

This test measures how well your child’s cochlea, or inner ear works. The outer hair cells of the inner ear (cochlea) produce low level, inaudible sounds, called Otoacoustic emissions (OAE’s). OAE’s can either occur spontaneously or in response to clicks or tones. When the hair cells of the inner ear are stimulated, they respond by sending information to the brain and by sending an “echo” back to the outer ear. This “echo” is analyzed and recorded by the audiologist. OAE’s are usually present in individuals with a normal functioning cochlea but may be absent if even a mild conductive or cochlear hearing loss exists.

How it is performed

This test requires the child and everyone in the room to be very quiet for the measurement to be obtained. Your child will hear soft sounds played through a small ear phone. The response from the ear will be measured by a hand-held computer. This test only takes a few minutes to complete.

What happens if my child has a hearing loss?

Some hearing losses can be medically or surgically corrected. Other types require the use of hearing aids and/ or cochlear implants.

>> Back to top

Now My Child Has a Device - Now What?

Coming Soon ...

Reading An Audiogram

Audiogram Animation

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

What an audiogram tells you about your child’s hearing:

  • Does my child hear the same in both ears?
  • How much hearing loss does my child have?
  • What type of hearing loss does my child have?
  • Does my child require hearing aids?

Reading an audiogram
Types and configurations
Hear examples of hearing loss

Hearing Loss Simulator

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

>> Back to top

Hearing aids

Hearing Aid Evaluation

At this appointment, your audiologist will explain the different types of hearing aids that are appropriate for your child’s hearing loss. Hearing aids come in many sizes and colors. Your audiologist will help guide you to pick the hearing aid that most closely matches the needs of your child and his or her environment.

Hearing Aid Fitting

At the hearing aid fitting, the chosen hearing aid will be fit to your child’s ears. This appointment lasts approximately two hours. During this visit your audiologist will:

  • Run tests on the hearing aid(s) to make sure it is working appropriately
  • Fit the hearing aid to match your child’s hearing loss
  • Cover care and maintenance of the hearing device
  • Complete a hearing test with the hearing aid(s)

Hearing Aid Check

Hearing aid checks are follow up appointments that occur after a hearing aid fitting. At these appointments your audiologist will check to make sure the hearing aid is functioning properly as well as answer any additional questions you may have.

Cochlear Implants

  • Pre-evaluation
  • Audiological / Medical Appointments
  • Schedule of Appointments
  • Inside a Typical Appointment

Additional services and devices provided throughThe Hearing Device Center

  • FM Systems
  • Music earplugs
  • Assistive listening devices (ALDs)
  • Aquanots Swim Plugs

Next Steps

Early Intervention Team

When a baby refers on the newborn hearing screening, the results are sent to the Hearing Coordination Center (HCC) (learn more). This center works with the family to ensure that the baby is receiving appropriate follow up care. The HCC will work with the family to begin Early Intervention Services. All children with documented disabilities from birth to age three are eligible to receive services. These services may include, but are not limited to:

  • audiology
  • family training, counseling, and home visits
  • occupational therapy
  • physical therapy
  • psychological services
  • service coordination (case management)
  • speech and language services

In addition to state funded services, you have many additional resources available for your child’s speech and language development. Ask your audiologist about additional language therapy, private schooling options, and courses dedicated to educating parents on hearing loss and language development.

Your family’s rights

Federal law governs your rights to Early Intervention Services. This law is called IDEA (the Individuals with Disabilities Education Act). If your child is under 3, their services will be described in a document called an IFSP (Individualized Family Services Plan). If your child is over age 3, their services will be described in ad document called an IEP (Individualed Education Plan). –Visit idea.letthemhear.org to learn more about these documents and the process and law governing the creation of these documents.

Additional Resources

Communicate with your child website
Attention Deficit Disorder & Hearing Impairment

Cochlear Implant Patient Speaking at Fundraiser Event

Chelsea had an atresia microtia surgery at the CEI Medical Group to restore her hearing

CHELSEA Cheadle is hoping to lead a chorus of support for Queensland's hearing-impaired children when the Butterfly Appeal takes flight this year.

The seven-year-old was born with underdeveloped ears and complete closure of the ear canal, but learned to speak, hear and listen, after help from the Hear and Say Foundation.

She stole the show yesterday at the launch of the Hear and Say Centre's Butterfly Appeal alongside what is believed to be Australia's first oral choir for deaf children.

Chelsea's mother Simone said the Hear and Say Centre has given her daughter the opportunity to attend school and fit in with other children.

"Because of therapy Chelsea has been given a new lease on life, she loves going to school and we are very proud of her."

The centre, which provides support to children born with hearing loss, is raising funds to allow more children to receive therapy. The appeal runs until April 28.

Click here to watch Video Clip

>> Back to top

Hearing Aids & Doctors in the Bay Area Home Page Hearing Aids Bay Area California Hearing Aid Options Hearing Doctors and Audiologists Meet Our Staff Hearing Appointments Palo Alto Contact Us


Page Quick Links: