hearing loss in children

Testing for Hearing Loss in Children

Maureen O'BrienChild Development, Special Needs Diagnoses

Hearing loss in children can cause delays in speech and language as well as academic skills later in childhood. Early intervention speech language pathologists work with many families of young children with speech and language delays. These families are often concerned that their child may have a hearing loss or that the child does not hear properly due to constant ear infections. They have a lot of concerns and questions regarding the process of hearing testing in children who are not able to participate well in a hearing evaluation. Here are some frequently asked questions:

Should I get my child’s hearing tested?

If a parent has concerns about a child’s hearing, they are encouraged to have the child tested for a hearing loss.

Some risk factors for hearing loss in young children include: Neonatal Intensive Care Unit (NICU) stay of 5 or more days; severe jaundice; prenatal infection such as German measles (Rubella) or cytomegalovirus (CMV); abnormal shape of head, face, or ears; syndrome or disorder related to hearing loss such as Usher Syndrome or Waardenburg Syndrome; history of meningitis; hospitalization for a head injury; medication use that may have damaged hearing; history of high fever; history of persistent ear infections; and family history of childhood hearing loss.  If your child has one or more of these risk factors, his or her hearing should be evaluated.

Some symptoms of hearing loss in babies (under 1 year of age) include: lack of or inconsistent response to loud sounds, not turning in the direction of a sound by 6 months, or no words by 1 year of age. Some symptoms of hearing loss in toddlers or preschool children include: few words/phrases, you cannot understand 50-75% of the child’s speech, unable or unwilling to follow spoken directions, responds a lot with “what?” or “huh?”, or wants the TV or music turned up too high. If your child presents with one or more of these symptoms, you should have his or her hearing evaluated.

Where should I go to get the testing done?

The American Speech-Language-Hearing Association (ASHA) has a database of certified audiologists (professionals who test hearing and help people manage hearing loss) that is available to the public at http://www.asha.org/findpro/ or 800-638-8255. Not all audiologists have the equipment or experience needed to test young children so whenever possible, parents should ask for an audiologist with pediatric experience. Parents can contact their child’s health insurance providers to see if the audiologists are covered under the child’s policy.

How will they test my child’s hearing?

Most adults remember having their hearing screened at school in which they put on headphones and raised their hand if they heard a sound.  Babies and young children cannot respond in this way so testing their hearing is much more challenging. There are a variety of methods that audiologists can use to determine if a child has a hearing loss. These are the ones most commonly used in young children.

The methods that require no participation from the baby or child are auditory brainstem response (ABR)/auditory evoked potential (AEP) and otoacoustic emissions (OAE). In an ABR or AEP, the audiologist is testing the inner ear and the nerves. The child is either resting or sleeping (sometimes they are sedated) and electrodes are placed on his or her head so that they can measure how the brain responds to sounds. OAE testing involves a probe placed in the child’s ear.  When the inner ear responds to sound, it makes a sound in return that travels back through the middle ear. If the inner ear is not functioning properly, these sounds may be absent.

For slightly older children (6 months and up) who may be able to participate more consistently, pure tone testing can be used. This is what most people think of when they think of a hearing test. Audiologists can train a child to look to the source of a sound by placing a TV screen or other object there that moves when a sound is made. The child sits with the parent in a sound booth and either listens through earphones or the sound comes through a speaker. When the sound is made, the object/picture moves to encourage the child to look. After several times, the sound is made and they wait for the child to look to show that he or she heard the sound. For children over 2, they can sometimes teach the child to put a block into a bucket or a ring onto a post when they hear the sounds.

Audiologists test children’s middle ear function with a method called tympanometry. This can tell them if there is fluid in the middle ear or a hole in the ear drum. They place a probe into the child’s ear and push a small amount of air into the ear canal to see how well the eardrum moves. This is especially important with children who have experienced many ear infections.

How much does the hearing test cost?

Many health insurance policies including Medicaid and Medicare cover hearing tests within their networks. Contact the child’s insurance provider to determine how much would be covered and what the family’s out-of-pocket responsibility would be.



Auditory Brainstem Response (ABR). Retrieved from http://www.asha.org/public/hearing/Auditory-Brainstem-Response/

Otoacoustic Emissions (OAEs). Retrieved from http://www.asha.org/public/hearing/Otoacoustic-Emissions/

Pure-Tone Testing. Retrieved from http://www.asha.org/public/hearing/Pure-Tone-Testing/

Tests of the Middle Ear. Retrieved from http://www.asha.org/public/hearing/Tests-of-the-Middle-Ear/

When should a child be referred for a hearing test. Retrieved from https://canadianaudiology.ca/consumer/hearing-test-referral.html

(2007). Just in time. Retrieved from http://www.cdc.gov/ncbddd/hearingloss/facts.html

(2010). Your baby’s hearing and communicative development checklist. Retrieved from http://www.nidcd.nih.gov/health/hearing/pages/silence.aspx