Hearing loss in childrenHearing loss in children

Hearing loss at birth: Significant effects on Hearing loss at birth: Significant effects on development of speech and language. May start to development of speech and language. May start to become more obvious as child grows. become more obvious as child grows.

Even mild hearing loss can have significant effects. Even mild hearing loss can have significant effects.

Risk factors for Risk factors for neonatesneonates: Low APGAR scores, : Low APGAR scores, family history, syndrome, illness, craniofacial family history, syndrome, illness, craniofacial disorders, in-utero infection and medications.disorders, in-utero infection and medications.

Universal hearing screening: Based on high-risk Universal hearing screening: Based on high-risk registry.registry.

Objective tests for neonatal and infant Objective tests for neonatal and infant hearing screening/testinghearing screening/testing

ABRABR OAEOAE TympanometryTympanometry Acoustic reflexesAcoustic reflexes

Important to use age-appropriate norms Important to use age-appropriate norms and to multiple tests whenever possible.and to multiple tests whenever possible.

Behavioral hearing tests in childrenBehavioral hearing tests in children

Important to know normal responses to Important to know normal responses to differentiate them from children with problems. differentiate them from children with problems.

Responses: Voluntary or involuntary movements, Responses: Voluntary or involuntary movements, vocalization, electrophysiological.vocalization, electrophysiological.

Thresholds typically higher because of the nature Thresholds typically higher because of the nature of the response.of the response.

Behavioral methods for testing Behavioral methods for testing children upto 2 years of agechildren upto 2 years of age

Behavioral observation audiometry (BOA): For very young Behavioral observation audiometry (BOA): For very young children (First 6-8 mths of age). Present various stimuli and children (First 6-8 mths of age). Present various stimuli and observe child’s reaction.observe child’s reaction.

Sound-field audiometry: For older children (upto 2 years) Sound-field audiometry: For older children (upto 2 years) Use of multiple loudspeakers, present stimuli, observe Use of multiple loudspeakers, present stimuli, observe responses.responses.

Conditioned orientation reflex (COR): Pair auditory Conditioned orientation reflex (COR): Pair auditory stimulus with visual stimulus till child associates the stimulus with visual stimulus till child associates the

two.two.

Visual reinforcement audiometry (VRA): Use Visual reinforcement audiometry (VRA): Use reinforcers to reinforcers to encourage correct responses.encourage correct responses.

Behavioral methods for testing Behavioral methods for testing children between 2-5 years of agechildren between 2-5 years of age

Can use stimuli with greater frequency-specificity.Can use stimuli with greater frequency-specificity.

Use warble tones (frequency-modulated pure Use warble tones (frequency-modulated pure tones)tones)

Speech audiometry using picture responses.Speech audiometry using picture responses.

Pure tone audiometry in some cases.Pure tone audiometry in some cases.

Play audiometry: Example: Placing blocks into a Play audiometry: Example: Placing blocks into a bucket when a tone is heard.bucket when a tone is heard.