Hearing tests

Infants and children

Hearing problems, even those that are mild, can delay your child's speech and language development. Early screening for hearing loss can help prevent a variety of learning, social, and emotional problems that can be related to speech and language development.¹

Hearing tests may be a part of a well-child appointment. In most hearing tests, your child responds to how well he or she hears a series of tones or words (subjective testing). Hearing is also tested by examining your child's ears or by using an instrument to measure how the ears react to sound (objective testing). In objective testing your child is not asked to respond to sounds. The Committee of Practice and Ambulatory Medicine and the American Academy of Pediatrics have recommended that:²

• Newborns' hearing should be tested with a hearing test (objective testing).
• Children ages 1 through 12 months should be tested by asking you about your child's hearing.
• Children at 15, 18, and 24 months and 3 years should be tested subjectively.
• Children 4 years old should be tested objectively.
• Children ages 5 to 10 years old should be tested objectively at 5, 6, 8, and 10 years old.
• Children and teens ages 11 to 21 should be tested objectively at 12, 15, and 18 years old and be tested subjectively at the other yearly checkups.

Birth to 28 days

If your newborn has one or more high-risk factors, it is particularly important to have these hearing tests. These risk factors include:³

• A family history of hearing loss.
• Certain infections of the mother during pregnancy. These include toxoplasmosis, rubella, genital herpes, and syphilis.
• An ear or other face or skull abnormality, such as cleft lip and palate.
• Jaundice that requires a blood transfusion.
• A birth weight less than 3.3lb.
• Bacterial meningitis.
• Low Apgar scores (0 to 3 at 5 minutes, or 0 to 6 at 10 minutes).
• Problems breathing.
• Having had mechanical ventilation for more than 10 days.
• Using medicine that may cause hearing loss (ototoxic medicines) for more than 5 days.
• Having physical features that are often seen with a disease that results in hearing loss, such as Down syndrome.

29 days to 24 months

When your child is between 1 month and 24 months old, a hearing test is important if your child has:

• Any of the newborn risk factors listed above.
• Received a blow to the head that causes a broken bone.
• A disease often seen with hearing loss, such as mumps or measles.
• A disease of the brain or nervous system, such as Charcot-Marie-Tooth syndrome, which can result in muscle weakness, primarily in the legs and sometimes in the hands.

Call your doctor if at any time you suspect your child has a hearing problem, such as if your baby does not seem to respond to loud noises or your young child is not making sounds or talking at the expected ages.

An audiologist may check a baby's hearing using several different methods. One method, called otoacoustic emissions (OAE) testing, is done by placing the small, soft tip of an instrument in a baby's ear canal to measure the inner ear's response to sound. In auditory brain stem response (ABR) testing, sounds are emitted from the soft tip of an instrument placed in the baby's ear canal. Three small electrodes placed on the surface of the baby's head record the brain's response to the sound. Both tests are best performed when the infant is quiet.

After 6 months of age, your child may be tested with conditioned play audiometry (CPA). In this kind of testing, children respond to a number of different high-pitch and low-pitch (frequency) sounds, as well as to speech.

Many states in the United States require newborn hearing tests for all babies born in hospitals. Also, many health organizations and physician's groups recommend routine screening. Talk to your doctor about whether your child has been or should be tested.

Adults

Adults are tested at their regular checkups. Subjective tests are generally used.

Citations

1. Joint Committee on Infant Hearing, American Academy of Pediatrics (2000). Principles and guidelines for early hearing detection and intervention programs. Year 2000 position statement. Available online: http://www.aap.org/policy/jcihyr2000.pdf.

2. Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics (2000). Recommendations for preventive pediatric health care (RE9939). Pediatrics, 105(3): 645. Also available online: http://www.aap.org/policy/re9939.html.

3. Cunningham M, et al. (2003). Hearing assessment in infants and children: Recommendations beyond neonatal screening. Pediatrics, 111(2): 436–440.