Well-Child Care Toolkit

Hearing Screening Methods

Visual Reinforcement Audiometry (VRA) (6 - 24 months)

VRA is the recognized method for testing very young children, ages 6 months to 2 years. In this procedure, stimulus tones and visually animated reinforcers (e.g., lighted toys) are paired and presented together.

After the child has been conditioned to expect a relationship between the visually animated reinforcers and sounds, the visual reinforcer is withheld and the sound is presented alone. The child looks for the visual reinforcer in response to the sound, and the visual reinforcer is then presented as a reward.
(Noncalibrated toys or noisemakers and signals that lack frequency specificity are inappropriate screening methods.)1

Screening Protocol

Test each ear separately. Teach the child the desired motor response before screening, and administer at least two conditioning trials at a presumed suprathreshold level to ensure that the child understands the task. If possible, screen with earphones (conventional or insert earphones) using 1000, 2000, and 4000 Hz tones at 30 dB HL (higher than in CPA).

Present the sound stimulus at least two times at each frequency. (If the child refuses earphones or cannot wear them, present the stimuli in a calibrated sound field. EOAE or ABR may also be used.)

Pass/Refer Criteria

Pass if the child responds at criterion dB level at each frequency in each ear.

Refer if the child does not respond at criterion dB level at any frequency in either ear.

Source

1 American Speech-Language-Hearing Association, Panel on Audiologic Assessment. 1997. Guidelines for Audiologic Screening. Rockville, MD: American Speech-Language-Hearing Association.

Conditioned Play Audiometry (CPA) (24 months and older)

CPA is the most commonly used behavioral audiometric procedure for preschool children. This method may be used with children beginning at about 2 years of age. In CPA, the child is taught to play listening games, using blocks, rings, or other objects. The child learns to wait and listen for a sound, and to perform a motor task in response. The motor task is a play activity, which serves as reinforcement.

(Noncalibrated toys or noisemakers and signals that lack frequency specificity are inappropriate screening methods.)

Screening Protocol

Test each ear separately. Teach the child the desired motor response before screening, and administer at least two conditioning trials at a presumed suprathreshold level to ensure that the child understands the task.

Present the test stimulus at least two times at each frequency. If the child can reliably participate in CPA or conventional audiometry, screen under earphones (conventional or insert earphones) using 1000, 2000, and 4000 Hz tones at 20 dB HL.

Hearing screening must be done with audiometric equipment that is calibrated in accordance with American National Standards Institute (ANSI) standards and in locations where ambient noise levels meet ANSI standards and reliable and valid measures can be obtained. Handheld audiometers have not been proven effective.

Pass/Refer Criteria

Pass if the child’s responses are judged clinically reliable at criterion dB level (20 dB) at each frequency in each ear.

Failure to respond to threshold levels of 20 decibels at 1000, 2000, and 4000 Hz tones indicates possible hearing impairment. If the child or teen does not respond at criterion dB level at any frequency in either ear, teach the desired motor response again, then reposition earphones and rescreen.

Refer if the child does not respond at least two of three times at the criterion dB level at any frequency in either ear, or if the child cannot learn the task.

Source

1 American Speech-Language-Hearing Association, Panel on Audiologic Assessment. 1997. Guidelines for Audiologic Screening. Rockville, MD: American Speech-Language-Hearing Association.

Conventional Audiometry (middle childhood and adolescence)

In this test, the child or teen wearing earphones responds by raising a hand when he or she hears a tone. This method is more successful with children ages 5 years and older who have developed greater attention to task and greater ability to respond reliably.

Screening Protocol

Test each ear separately. Screen under earphones using 1000, 2000, and 4000 Hz tones at 20 dB HL. Perform conventional audiometry in a quiet environment, since ambient noise can significantly affect test performance, particularly at lower frequencies. The use of speech stimuli instead of frequency-specific stimuli is not recommended.

Hearing screening must be done with audiometric equipment that is calibrated in accordance with American National Standards Institute (ANSI) standards and in locations where ambient noise levels meet ANSI standards and reliable and valid measures can be obtained. Handheld audiometers have not been proven effective.

Pass/Fail Criteria

Pass if the child’s responses are judged clinically reliable at criterion dB level (20 dB) at each frequency in each ear.

Failure to respond to threshold levels of 20 decibels at 1000, 2000, and 4000 Hz tones indicates possible hearing impairment. If the child or teen does not respond at criterion dB level at any frequency in either ear, reinstruct, then reposition earphones and rescreen within the same screening session.

Pass those who pass rescreening.

Refer those who fail rescreening or who cannot learn the task.


Source

1 American Speech-Language-Hearing Association, Panel on Audiologic Assessment. 1997. Guidelines for Audiologic Screening. Rockville, MD: American Speech-Language-Hearing Association.
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