There are several tests that may be completed during your child’s appointment with an audiologist based on their age and the reason for their visit. At their appointment, the audiologist will perform tests that assess the health of your child’s outer, middle, and inner ear.
The outer ear includes their pinna, the portion of the ear visible to the outside, and their ear canal up to the tympanic membrane (eardrum). The middle ear includes the space behind the tympanic membrane and the three bones of hearing. The inner ear includes the cochlea (organ of hearing), which codes sounds into a signal that is sent up the auditory nerve to be processed in the brain.
The audiologist will take a look in and around the ear assessing the appearance of the outer ear, including the ear canal, tympanic membrane, and the surrounding structures for cerumen (ear wax), drainage, and signs of inflammation or irritation.
A test of the tympanic membrane and middle ear function. A probe is placed at the opening of the ear and assesses pressure in the middle ear space. This test is not determining how well a child is hearing, but can indicate if any fluid or congestion may present in the middle ear space, which could be affecting their hearing.
A test of the function of the inner ear, specifically the outer hair cells in your child’s hearing organ, the cochlea. A small probe is placed in the ear canal and soft whistle-like sounds are played into the ear canal. In a typical healthy ear, when the hair cells are stimulated by an incoming sound, they produce an echo that travels back out the ear canal. If this echo is picked up by the probe, it indicates healthy cochlear function. This test serves as an objective hearing screening that can rule out anything more than a mild hearing loss.
Auditory Brainstem Response Testing
Before a child is old enough to respond to sounds with reliability, a hearing test will be performed using electrodes to monitor your baby’s brain activity in response to sounds played through headphones in their ears. In order for the electrodes to be able to pick up signals clearly, the baby must be asleep for testing. It is recommended this test is scheduled during their anticipated nap time or right after eating.
Visual Reinforcement Audiometry
Between the ages of 6 months and toddlerhood, hearing thresholds are established by playing sounds through a speaker and training your child to look for the source of the sound by rewarding them with a toy that lights up next to the speaker. Hearing thresholds are established by determining the softest level where they sought out the sound source.
Conditioned Play Audiometry
As your child ages, they will outgrow visual reinforcement audiometry and will learn to perform a task in response to a sound under headphones. Every time they hear the beeps, they will throw a block in a bucket, add a peg to a tower, or somehow demonstrate they heard the sound. If your child is struggling with this task, it can easily be replicated at home. Grab blocks and a bucket and play a sound, ring a bell, or simply say “beep beep” and guide them to show you they heard by tossing the block into the bucket. Familiarity with the game can help speed up the learning process when you come in for their appointment.
Starting around age five, children can start to participate in traditional hearing tests by pressing a button, clapping, or raising their hand when they hear each sound. The child may also be asked to repeat words back to the audiologist to assess their speech recognition abilities.