Comprehensive Hearing, Pediatric and Specialized Testing

Comprehensive Hearing Test

CASE HISTORY:

The audiologist will ask some questions about your symptoms, including how long you have been having problems with your hearing, whether you have ringing in your ears or dizziness, and other questions relating to your symptoms.

OTOSCOPIC INSPECTON:

The audiologist will look into your ears with a light called an otoscope to look for wax, drainage or other abnormalities in the ear canals. If there is something blocking the ear canal, you will be referred to the doctor before further testing can be completed.

TYMPANOMETRY:

A probe capped with a soft plug is placed in the outer portion of the ear canal. The patient may hear a humming sound and may feel a slight pressure change in the ear similar to that felt when taking off/landing in an airplane, driving up a mountain, or riding up a tall elevator. This test gives information about the eardrum and the middle ear. It shows how the eardrum is moving and can indicate if there is fluid behind the eardrum or a hole in the eardrum.

ACOUSTIC REFLEXES:

This test checks to see how a tiny muscle in the middle ear contracts when a loud sound occurs. You will hear some loud tones in your ears. The threshold values of the acoustic reflexes aid the diagnosis of the cause of hearing loss in some cases. Absence of the acoustic reflexes may also be diagnostically significant.

AUDIOMETRY:

Audiometry is the medical term for a hearing test. A comprehensive hearing test includes pure tone air conduction testing, bone conduction testing, and speech testing as described below. Depending on the purpose of your visit, you may receive all portions of audiometry testing or just one or two of the subtests.

PURE TONE AIR CONDUCTION:

Pure tone air conduction testing identifies the faintest sound that a person can hear. The patient is asked to raise their hand or push a button to indicate that they heard a sound. Results are recorded on a graph called an audiogram.

BONE CONDUCTION:

Bone conduction testing is obtained by putting a bone oscillator (a little box that vibrates on a head band) behind the ear. The patient listens to soft tones and is asked to respond with a button push or a hand raise to indicate that a sound was heard.

SPEECH TESTING:

Speech testing includes speech threshold testing and speech recognition testing. Speech threshold testing is completed by having the patient repeat words that get progressively softer and louder to determine the lowest level that speech is correctly understood. During speech recognition testing, the audiologist presents a list of words at a comfortable listening level. A percentage score is given for the number of words correctly identified by the patient.

Pediatric Hearing Assessment

Testing pediatric patients can be challenging for all involved. Below are suggestions for parents/caregivers to help the audiologists get the most out of each testing visit:

  • Try to avoid scheduling the appointment during naptime.
  • Bring snacks/drink for just before the appointment or for if the patient needs to take a break during the appointment.
  • Practice headphone use at home by having the child listen to music, because wearing headphones for the first time can be scary for some children.
  • Practice with an “otoscope” (the light and magnifier used to look in ears) at home. Use the otoscope from a play medical kit or a small flashlight to pretend to look in the child’s ears or the ears of their favorite stuffed animals or dolls.

The pediatric hearing assessment may include the following tests depending on the patient’s age and development:

TYMPANOMETRY:

A probe capped with a soft plug is placed in the outer portion of the ear canal. The patient may hear a humming sound and may feel a slight pressure change in the ear similar to that felt when taking off/landing in an airplane, driving up a mountain, or riding up a tall elevator. This test gives information about the eardrum and the middle ear. It shows how the eardrum is moving and can indicate if there is fluid behind the eardrum or a hole in the eardrum.

VISUAL RESPONSE AUDIOMETRY (VRA):

This type of test is used to determine hearing levels for pediatric patients who are developmentally between the ages of 6 months to 2 years old. The patient sits on the parent or caregiver’s lap inside a sound-treated booth. The audiologist plays speech sounds and puretones (beeps) or narrow band noise (static) out of two stereo speakers inside the sound booth. One speaker is slightly to the patient's right and one speaker slightly to the patient’s left. When the sound is presented out of the speaker the patient turns his head towards the sound and a light-up toy is turned on above the speaker to encourage the patient to continue turning his head towards the sounds even at soft levels. The goal is to find the softest sounds that the patient can hear for at least 4 different pitches. However, with this age group multiple visits are sometimes needed to obtain all the necessary information as the patient may tire of the task. The parent or caregiver’s role during this test is to hold the patient on his or her lap in a forward-facing position. The parent or caregiver should attempt to make no response to the sounds themselves so that the patient does not cue off their response.

CONDITIONED PLAY AUDIOMETRY (CPA):

This test uses a toy or a game to determine hearing levels for pediatric patients who are developmentally between the ages of 2½ years to 5 years old. The patient sits on a chair or at a small table inside a sound booth. The audiologist will place headphones over or in the patient’s ears. The patient’s parent or another audiologist or staff member may be asked to be the “play partner”. The audiologist plays puretones (beeps) or bursts of narrow band noise (static) into one ear via the headphones. The play partner helps the patient use the toy or game to indicate that they heard the sound. For example, the play partner may give the patient a block, have her hold it up to her ear and then drop the block in a bucket when the sound is presented. This is repeated at a medium loud volume until the patient learns or is “conditioned to” the task. Then the play partner will stop assisting the patient with dropping the block and have the patient continue the task for softer and softer sounds at multiple pitches in each ear until the patient fatigues of the task or until at least 4 pitches are tested in each ear. Similarly to VRA, the patient may need to return for multiple visits to obtain all the necessary information as some patients quickly fatigue of the task.

SPEECH RECOGNITION TESTING (SRT):

The goal of this test is to determine the softest speech sound the patient can understand. This test is also administered to adult patients but the pediatric test protocol is often different. The patient sits on a chair or at a small table inside a sound booth. This test can be completed in each ear with headphones on or if the patient is unable to tolerate the headphones it can be completed via stereo speakers in the sound booth. There are several techniques that are used with this test but with each technique the audiologist presents a word and with each response from the patient decreases the volume of the next word until the softest words that the patient can respond to are identified. If able, the patient is asked to repeat words spoken by the audiologist. The audiologist may also use a “point to picture” task where the patient has 6-12 different pictures in front of them, then, when the audiologist says a word, the patient points to an image of that word such as “baseball” or “airplane”. Another variation is for the audiologist to say a body part or type of clothing and for the patient to point to that body part on themselves or their caregiver. For example, the audiologist might ask the patient “where are your eyes” or “where are your shoes”.

Specialized Testing

AUDITORY BRAINSTEM RESPONSE (ABR):

ABR testing is an objective, electrophysiological measure of the status of the auditory nerve pathway from the inner ear to the brainstem. In this test, electrodes (similar in appearance to stickers) are placed on a patient’s forehead and insert earphones are placed in the ears. While sitting comfortably with the patient’s eyes closed, a clicking sound is presented to one ear at a time.

Results of the ABR are helpful in the diagnosis of tumors of the eighth cranial nerve (hearing and balance nerve), auditory neuropathy (a hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired), and vascular lesions (strokes) of the brainstem. ABR can also serve as a means of hearing threshold estimation in infants, as they are unable to provide a behavioral response, or other difficult to test patients.

OTOACOUSTIC EMISSIONS (OAE):

An otoacoustic emissions (OAE) test is an objective, electrophysiological test in which stimuli are presented to the ear and a response is generated by a healthy inner ear. It is a test, along with the ABR, that is included in the assessment of infants who have failed their newborn hearing screening and require follow-up testing. Results can be obtained whether a child is awake or asleep as long as they are in a quiet state. Used in conjunction with other electrophysiological tests, OAE measurements can assist in determining the functional status of the auditory system. While it is not a test of hearing sensitivity, OAE tests are helpful in determining the integrity of the auditory system in babies, children, and anyone who is unable to reliably participate in behavioral audiological evaluations. Results may also be used to rule out disorders such as auditory neuropathy.