Hearing Tune

Hearing assessments for children


	Various types of test are used to assess the hearing status of children. Selection of test depends on the child's mental age and cognitive ability. Behavioral tests require careful observation of the child's behavioral responses to different sounds (low to high pitch). The Audiologist will record the child's facial expressions, head-turns or hand-raise responses during the assessment. Objective tests are used for uncooperative children who cannot be tested behaviorally due to limited attention span, developmental delay or other medical problems. Hearing assessments designed for different age groups are as follows:

	Children (over 6 years old)
	-	Pure Tone Audiometry (PTA)
	-	Impedance Audiometry

	Children (3 - 6 years old)
	-	Play Audiometry
	-	Impedance Audiometry

	Toddlers / Infants (1 - 3 years old)
	-	Distraction Test
	-	Visual Reinforcement Audiometry (VRA)
	-	Otoacoustic Emissions (OAEs) Test
	-	Impedance Audiometry

	Newborns (0 - 1 year old)
	-	Auditory Brainstem Response (ABR) Test
	-	Otoacoustic Emissions (OAEs) Test

	Distraction Test
	The child is required to sit on parent’s lap. Different signals, like speech sounds /s/, /sh/ and /m/, sounds generated by high frequency rattle, chime bar, drum, cup and spoon are presented randomly next to the child’s ears. Sharp and reliable head-turn responses or eye movements towards the direction of sound source are expected to be noted during the test.

	Visual Reinforcement Audiometry (VRA)
	The child is conditioned to respond to sounds (low to high pitch) with head turning towards the direction of sound sources. Correct responses will be reinforced by the presentation of visual stimuli, e.g. animated puppets. Speakers are located in the front sides of the child.

	Play Audiometry
	The child is required to wear the earphones and the hearing level of each ear is assessed independently. The child is conditioned to perform some simple tasks, such as placing a peg on the pegboard after noticing the presence of any sound during the test.

	Impedance Audiometry
	Impedance Audiometry consists of two tests, namely Tympanometry and Acoustic reflex test.

	Tympanometry is used to assess the middle ear status, e.g. the integrity of the eardrum. A tiny ear tube is placed in the ear canal, air pressure and soft sounds are then presented to the ear canal through the ear tip. Abnormal findings will be noted if middle ear problem is present, e.g. middle ear infection or eardrum perforation.

	Acoustic reflex test measures slight changes in the eardrum induced by the two muscles in the middle ear, which contract in response to loud sounds, for evaluating the nature and degree of hearing loss. The contraction responses are measured either ipsilaterally or contralaterally. Ipsilateral measurement is to stimulate one ear and measure the changes in the same ear, whereas contralateral measurement is to stimulate one ear and measure the changes in the opposite ear.

	Otoacoustic Emissions (OAEs) Test
	This test is used to assess the function of inner ear hair cells. A tiny probe tube is placed in the ear canal and series of pulse-type sounds are presented. “Echo" responses from the inner ear are recorded automatically by the computer to evaluate the inner ear status.

	Auditory Brainstem Response (ABR) Test
	This test is used to assess the degree and type of hearing loss for uncooperative or unresponsive people. Tiny earphones are inserted in the ear canals and three electrodes are affixed to the head. When click sounds are presented to the ears, electrodes automatically collect the brainstem responses to sounds for evaluating the nature and degree of hearing loss. Because excessive body movements will influence the test results, babies / infants / children will undergo mild sedation procedure to make sure that they will stay very calm during the test.

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