Pediatric Hearing Evaluation

Pediatric testing is available for infants and children too young to reliably complete an adult hearing evaluation. The two behavioral tests utilized are visual reinforcement audiometry and conditioned play audiometry.

For infants and young toddlers (ages 6 months to 2.5 years), visual reinforcement audiometry (VRA) is most commonly used. For VRA testing the child must be able to sit upright and turn their head from side to side. During VRA testing the child is seated on the caregiver’s lap and is conditioned to turn his/her head to locate an auditory signal (speech, warble tone, or narrowband noise) being presented via speakers in the sound-field. VRA uses video screens to condition the child and reward them for locating the signal. The softest sound level that the child responds to (turns their head towards) is recorded on the audiogram. Because VRA is completed in the sound-field (without use of earphones or headphones), results are not ear-specific but reflect the hearing in the better ear.

For young children (3 to 6 years of age), conditioned play audiometry (CPA) is used. Unlike in VRA, CPA uses insert earphones or supra-aural head phones in order to test each ear independently. Depending on the cooperation of the child, the frequency range tested may be the same as in an adult evaluation or a reduced frequency range (500-4,000 Hz). The child will be conditioned to respond by stacking a block whenever a tone is presented. If the child will tolerate the bone vibrator headband, we will test tones using the headband as well. In order to determine a child’s speech threshold, they will be instructed to point to a picture located on a picture board (if the child is not familiar with the picture board words, the audiologist may ask him to point to different things in the room like his shoes, the chair, etc). If the child is able to verbally repeat words, a word recognition score can be found using a pediatric word list. The word recognition score indicates how well the child can understand speech at a conversational or comfortable level.