Hearing tests for children

Why are hearing tests so important for my child?

Hearing is the foundation of your child's ability to learn, so it's important to identify any problems as soon as possible. Regular hearing tests, starting just after birth and continuing through your child's grade school years, can help quickly identify hearing problems.

A child with untreated hearing loss may have delays in reaching developmental milestones, particularly in language and literacy. Depending on the degree of the hearing loss, without fitted hearing devices and early Listening and Spoken Language (LSL) intervention, their speech may be affected and sound "different" to others.

The sooner a child with hearing loss is diagnosed, receives quality pediatric audiology care, and is enrolled in early intervention, the more likely it is that their listening, language, and literacy development will be on track.

If your child failed their newborn hearing screening , you'll need to follow up with a pediatric audiologist right away for more complete testing.

Even if your child has no identified hearing loss, a healthcare provider will check their hearing at every well-child visit. Once your child is in preschool or grade school, routine testing will likely be available on a set schedule, at the beginning of the school year, for example. Check with your child's school to be sure. These are simple screenings, done with earphones, and the purpose is to identify potential hearing problems.

If there's any cause for concern – or if your child has risk factors for delayed-onset or progressive hearing loss – their healthcare provider will refer you for more testing with a pediatric audiologist (a hearing expert for children).

If your child's hearing loss is caused by persistent fluid behind the eardrum, you may be referred to another specialist, like a pediatric ear, nose, and throat doctor (ENT).

Feel free to talk about any concerns you have about your child's hearing with your healthcare provider or ENT and ask for a referral to a pediatric audiologist. You can also find an audiologist in your area through the American Academy of Audiology's website .

Trust your instincts – you know your child best. If you're concerned about your child's hearing, talk to a healthcare provider right away.

What happens during a hearing test?

Audiologists and ENT doctors use a variety of tests to get a complete picture of a child's hearing.

Before an audiologist conducts a hearing exam, they measure the mobility of your child's eardrums with a procedure known as tympanometry. They apply air pressure in the ear canal with a soft plastic-tipped device.

This will tell whether your child has fluid in the middle ear or a malfunctioning eustachian tube, which would affect the results of a hearing test. The procedure is quick, easy, and gentle.

The type of hearing exam your child gets depends on their age and abilities. A baby won't be able to follow directions to raise their hand when they hear certain sounds, for example, so the audiologist uses a test called Auditory Brainstem Response (ABR).

An ABR test determines your baby's hearing levels by analyzing the baby's brain waves in response to sound. This is done while your baby sleeps.

During an ABR test, electrodes are gently placed on the baby's head. Then, the audiologist plays sounds through earphones. The brain waves that occur in response to sound are recorded by a computer. The audiologist changes the pitch and volume of the signals to determine hearing levels in each ear.

With younger children, the audiologist will conduct a behavioral test and pay close attention to the child's reactions to a sound. Your child will sit in your lap in the center of a soundproofed room with speakers on both sides. When your child looks in the direction of the sound, they're rewarded by the sight of a dancing toy or a flashing light. This test is called visual reinforcement audiometry (VRA).

The audiologist records your child's responses to different levels of sound, looking for the softest level at which a child can hear speech and tones. They'll also note whether your child responds to speech and at what loudness level. Your child may ignore tones but acknowledge a voice, for example.

Children ages 3 to 5 can be taught to play a simple game, like dropping a block in a bucket when they hear a sound delivered through earphones. These tests are fun for the child, and the audiologist can obtain a complete picture of hearing in each ear using this technique.

A child 5 years old and older can reliably raise their hand or push a button when they hear a tone, just as an adult would. Kids this age can also typically repeat words when asked.

While one goal of behavioral testing is to make sure that your child's ears are hearing sounds, it also tests that their brain is processing them and responding correctly.

Behavioral tests may be followed by an otoacoustic emissions (OAE) test. This quick test shows how the ears are working for further confirmation of a hearing loss. OAE tests measure sound receptors in the inner ear.

The audiologist places a little device in your child's ear that makes soft clicking sounds. The sound receptors respond by vibrating, which produces a very quiet sound that echoes back through the middle ear, into the ear canal, and to the device. A computer connected to the device records the ear's response to the sounds.

Your child just needs to sit quietly for a few minutes for this test. The OAE can be used to quickly determine whether a child has normal hearing function.

What happens if my child doesn't pass the hearing test?

If the audiologist determines that your child has hearing loss in one or both ears, you'll begin to work with a team of professionals. This can include the pediatric audiologist, an ENT, and an early intervention professional, such as a speech-language pathologist (SLP).

If your child's hearing loss is related to fluid in the ear, the ENT will discuss appropriate options for helping your child hear better, which might include surgery.

If your child needs hearing devices, the audiologist will recommend and fit hearing technology to help your child hear. These devices include:

• Hearing aids, small electronic devices worn behind the ears to amplify sound
• A cochlear implant, a small electronic device that's surgically implanted and provides the auditory nerve with direct access to sound
• Bone conduction hearing aids, small electronic devices placed on the baby's head that send sound vibrations through the bones of the skull to the inner ear

The doctor and audiologist will also talk with you about how to teach your child to communicate, and how you can best communicate with your child. As a parent, you get to decide what outcomes you'd like for your child.

If you want your child to learn to listen and talk , look for an interventionist who specializes in listening and spoken language (LSL). They'll teach you research-based strategies and techniques to support your child's listening and language development.

You may pursue sign language for your child, or use a combination of sign and spoken language to communicate.

Will I be able to tell if my child can't hear?

You might not always be able to tell if your child has trouble hearing. There are degrees of hearing loss, and you may not notice that there's a problem. That's why regular testing is so important.

Your child may turn toward you when you talk or drop something, but this doesn't mean their hearing is fine. They may be able to hear some sounds but miss the critical sounds of speech that their brain needs to develop age-appropriate listening, talking, literacy, and other skills.

Parents and other caregivers are often the first to notice that something is amiss. If you notice any warning signs of hearing loss , don't hesitate to talk with your child's healthcare provider right away. The sooner hearing problems are diagnosed, the sooner your child can get help.