The Importance of Hearing Tests in Children

Author :-

Dr.Sreejaya

General Medicine & Diabetology

Introduction: Why Hearing Tests Are Essential for Children

The Role of Early Hearing Assessment in Child Development

Hearing loss affects newborns and infants at a rate of 1.1-3.5 per 1,000 tests. Auditory loss affects up to 20% of children by age 18, highlighting the need for proper diagnosis and treatment. Untreated hearing loss can cause speech and language difficulties, vestibular dysfunction, anxiety, depression, and low self-esteem.

How Hearing Impacts Language, Learning, and Social Skills

Mono or bilateral hearing loss. Recent clinical research has shown that unilateral hearing loss is clinically significant, despite its common perception. The development of binaural hearing pathways requires early, balanced input from both ears. Sound localization is harder without binaural hearing, especially in background noise because binaural squelching decreases. Unilateral hearing loss increases the likelihood of repeating a grade by tenfold (35% vs. 3.5%). Around 40% need further schooling.

Understanding Hearing Tests for Children

What is a hearing test?

Standard OAE, ABR, tympanometry, and age-appropriate audiometry equipment should be accessible. More on age-appropriate testing below. VRA is best for youngsters under two who can sit upright alone and tilt their heads toward sound. Usually about six months of corrected age.

We recommend conditioned play audiometry (CPA) from age two to five, or until the child can more meaningfully engage in an examination. We use standard pure-tone audiometry (PTA) after age five, or earlier if the child can participate. Adults and older children commonly undergo acoustic reflex testing, but infants and small children do not.

Difference Between Hearing Screening and Diagnostic Hearing Tests

Hearing screening involves visiting an ENT specialist with a complete case history. The concerned ENT specialist will ask about the issues, understand every aspect of the patent, and then prescribe or go into detail.

Diagnostic hearing tests involve screening through various mechanisms, including audiometry and the BERA test. Besides, testing often uses 2000–5000 Hz frequencies. Both TEOAE and DPOAE are suitable screening methods; however, a greater number of practices use TEOAE. With or without cochlear microphonics, the results are binary and qualitative: pass or refer.

Types of Hearing Tests for Children

Newborn Hearing Test

Use a soft-tipped immittance probe to maintain pressure in the test ear's ear canal. The child's external ear pressure varies with low-frequency sounds. Tympanic membrane movement is recorded. Most children over six months need a 226 Hz probe tone. Due to tympanic membrane rigidity, children under six months of age may have greater middle ear effusions detected by a 1000 Hz probe tone.

Pure-tone audiometry is standard. Patients over 5 generally undergo it; however, some may start earlier or later. Headphones let the patient hear different frequencies and intensities. Sound buttons accompany each sound. Kids reply vocally, raise their hand, or clap to sounds. Bilaterally retest frequencies until you calculate the threshold values.

Explanation of initial hearing assessments conducted shortly after birth.

Otoacoustic emissions, or OAE, test ear components for sound response. This test inserts a soft earphone into your baby's ear canal. We play a sound and measure the echo response in normal hearing ears. Your infant may have hearing loss without echo.

The ABR measures how the auditory nerve and brainstem (which convey sound from the ear to the brain) react to sound. This test involves placing small earbuds and painless electrodes on your baby's head. The electrodes adhere to the skin like stickers and can be removed painlessly.

Otoacoustic Emissions (OAE) Hearing Test

Overview of how OAE works and why it is commonly used in newborns.

Without specificity, OAE screening is limited. Noise from the test surroundings or inhaling and swallowing might cause false positives. During analysis, OAE may be hard to identify due to background noise. Most cases of OAE require the examination of repeatable data and a waveform signal-to-noise ratio. Since OAE passes through the middle ear, diseases such as effusion can cause damage to it. Even with healthy OHCs, children suffering from adhesive otitis may not experience OAE symptoms. OAE cannot discriminate between conductive and sensorineural hearing loss.

Auditory Brainstem Response (ABR) Test

How the ABR test measures the auditory nerve's response to sounds.

Auditory brainstem responses help identify 8th cranial nerve neurologic problems, auditory pathways, and hearing sensitivity for people who cannot offer behavioral hearing exam information. This information is necessary for diagnosing hearing loss, acoustic tumours, and CPA tumours. For patients who are unable to undergo standard audiometry, this activity focuses on the evaluation and management of hearing loss by the interprofessional team.

Visual Reinforcement Audiometry (VRA) is used for toddlers and young children; it involves sound and visual cues.

Infant hearing testing uses VRA. Operators connect audio and visual inputs. Various methods recommend VRA testing. Therapeutic VRA uses initial auditory stimulation without visual reward. Infants obtain visual incentives for head turning. This VRA study focused on unconditioned response rates (head position toward loudspeaker) to 1000-Hz narrowband noise (NBN) and frequency-modulated tones. We tested individual stimulus types on 100 VRA-presenting newborns, aged between 6 and 30 months, with a mean of 13 months. NBN babies responded 69% vs. 25% of FMT. Chi-squared showed NBN's edge. Conclusion: The non-conditioned head orientation response in VRA babies was better with 1000-Hz NBN stimulation than FMT stimulation.

Conditioned Play Audiometry (CPA)

Hearing test for preschool-age children using play-based activities.

Audiology clinics use Conditioned Play Audiometry5 (CPA), a single-interval adaptive method, to measure hearing sensitivity in children aged 2.5–5 years. CPA uses play-based motor activities like stacking blocks to produce a time-locked, conditioned response to an auditory input. Test assistants reinforce the child's responsive behaviour. According to various studies, CPA produces a conventional clinical audiogram for over 90% of normally developing 3-year-olds. Youthful youngsters produce much less.

Newborn Hearing Screening: The First Step in Hearing Health

Purpose and benefits of newborn hearing screening

When the brain is developing and maturing, the first three years are the most critical for learning language (spoken or signed). Normal-hearing children learn speech and language in the first six months. Screening and treating hearing loss early is crucial. Early intervention improves language abilities in hearing-impaired youngsters, according to research.

How newborn hearing screening tests are conducted

For this examination, we place a small, flexible plug in the baby's ear. Plugs transmit sound. A plug microphone records typical ear otoacoustic emissions. Deaf newborns are silent. This noninvasive test takes a few minutes while the baby sleeps.

Brainstem hearing: Glued electrodes touch the baby's scalp. Baby's tiny earphones click while sleeping. Noise-induced brain activity is monitored. This exam is short and painless, like EOAE.

Common Results and What They Mean for Parents

Hearing aids reduce hearing thresholds by 25 dB but perform worse than cochlear implantation in severe to profound hearing loss cases. Cochlear implantation matches control patients' hearing with 85% word reception checks. 95% of cochlear implanted patients do not need learning adaptations or full-time education, which reduces developmental delays.

Lack of screening or follow-up on negative results may delay hearing loss detection until the brain is less pliable. Integrating hearing aids is challenging.

Signs and Symptoms of Hearing Loss in Young Children

Recognising possible hearing issues in infants and toddlers

It's hard to estimate toddlers' and preschoolers' behavioural hearing thresholds. Because toddlers and preschoolers habituate faster, most clinic and laboratory operant techniques for infants don't work. Under-4s lack the cognitive development required to complete forced-choice behavioural assessments. Therefore, our understanding of infant-to-school auditory development is inadequate.

Developmental Milestones and Early Warning Signs for Parents

Baby's inner ear develops totally, and they have hearing after 20 weeks. Hence, they hear from birth. Babies learn from their ears. This boosts brain growth. Hearing loss delays speech, language, and voice development. Therefore, we must promptly detect any abnormalities in hearing.

Why Early Detection Matters: Impact of Hearing Loss on Development

Language and Speech Development Challenges

Since the brain is still developing, the first three years of life are crucial for learning speech and language. Sounds, visuals, and constant exposure to others' speech and language help develop these talents.

The brain absorbs language best in newborns and young children during essential speech and language development. Language learning will be harder without language contact throughout these important periods.

Social and Academic Implications of Undiagnosed Hearing Loss

Uncorrected hearing loss promotes isolation, less social interaction, and a sense of exclusion, which increases depressive symptoms, according to several studies. These results emphasise the need for early hearing loss detection and rehabilitation, including hearing aid fittings.

What to Expect During a Child’s Hearing Test

We are preparing for various types of hearing tests.

Naptime ABR testing for babies. Staying awake and sleep-deprived before surgery maximises sleep. For accurate results, insufficient sleep may require sedation or general anaesthesia. Maintaining calm throughout ABR tests reduces muscle or movement artefacts. Patients must provide medical history, medications, medicine allergies, and side effects before conscious sedation. Eight hours prior to anaesthesia, the patient must refrain from eating. Before putting on surface electrodes, the otolaryngologist scans the external auditory canals. Cerumen and debris removal prevents canal damage and bleeding, which reduces hearing. For middle ear effusion, doctors recommend a myringotomy with fluid evacuation and tube implantation. Ear fluid might hinder testing.

Helping Your Child Feel Comfortable During the Process

Boosting Confidence: Tell your youngster the test is safe. Your youngster will feel safer with a beloved toy or blanket.

Easily Explain the Procedures: Tell kids what will happen during the visit with simple words, drawings, or video (see link). Emphasise the significance of the examination and welcome any inquiries. To familiarise yourself with your child, try a fake hearing test at home.

Following Up After a Hearing Test

Understanding the Results of a Hearing Screening or Diagnostic Test

Because of undiscovered permanent congenital hearing loss, UNHS is done globally. There are an excessive number of UNHS false positives, which mistake normal ears for hearing loss. In 60-80% of babies who were referred for further testing, false positives led to an increase in medical interventions. Whenever possible, reduce referrals. Because they have lower referral rates and higher positive predictive values than EOAE protocols, several institutions utilise AABR UNHS procedures.

Next steps if hearing loss is detected (interventions, hearing aids, etc.)

The therapy chapter follows hearing loss detection. Hearing loss treatment varies by kind, lifestyle, personal preferences, and finances. Not all hearing loss patients can use hearing aids or other assistive technology (see Chapter 4). This report's task does not include medical or surgical therapies.

Importance of regular monitoring and ongoing hearing health

Following the fitting of hearing aids, it is customary to schedule a follow-up appointment. This follow-up allows the individual to share their experience with the audiologist and make adjustments, for the audiologist to provide further advice and support, including referral to other agencies as needed, for the audiologist to observe optimal device fitting and handling, and for patient-reported outcome and experience measures.

Conclusion

Clinical practice guidelines, standards of practice, performance measurements, and continuous quality improvement help encourage and achieve high-quality hearing health care. It's crucial to test hearing defects properly, but if a kid or infant has had them for a while, contact Ovum Hospital for a better understanding and treatment.

FAQs

1: How often do you check your hearing?

The American Speech-Language-Hearing Association (ASHA) recommends hearing tests every three to five years for healthy persons aged 18–40 without hearing loss.

2: Why Are Child Hearing Tests Important?

Hearing loss is challenging for youngsters. Hearing exams are the best method to discover hearing impairments early and provide your kid with the treatment they need to hear and speak properly. Hearing exams can detect developmental delays in children.

As hearing changes during infancy, it is important to conduct tests frequently. Talk to your doctor or audiologist about hearing tests for your kid and how often to have them. Hearing loss can influence your child's speech, language, and play and social skills.

3:What is the recommended schedule for my child's hearing tests?

Every child should undergo regular hearing examinations, particularly those at higher risk for hearing loss, such as preterm babies or those with a family history of hearing issues. You should conduct hearing exams every three years until your child turns seven, after which you should do them annually.

4: Listening; try out?

A hearing test, also known as a hearing screening or hearing examination, takes a few minutes and is painless to assess your child's hearing health. An expert measures and evaluates the ear's reaction to sound signals to determine the presence of any problems. Audiology clinic screening exam.

5: What's the neonatal hearing screening schedule?

Baby's initial hearing screening is 1–2 days after birth. Before going home, hospital deliveries usually include screening. Your baby's doctor will organise the hearing screen if you give birth at home, at a birthing centre, or within 24 hours.