Pediatric Hearing Tests

Pediatric hearing tests are kid-friendly ways to check for hearing loss in children. Your child may have a hearing test as a follow-up to newborn hearing screening. Or they may have one if you, a teacher or a healthcare provider notice possible hearing loss issues.

Hearing loss in children may be present at birth or develop later. About 1 to 2 in 1,000 babies are born with hearing loss. Early diagnosis and support can help babies and young children with hearing loss develop the same language skills as children with normal hearing.

Early diagnosis is important. Treatment and support can help your child develop strong speech, language and communication skills.

Your baby may have hearing loss if they:

• Don’t seem to notice loud noises or noises don’t make them startle
• Don’t respond to your voice or other familiar voices
• Don’t babble or use sounds by the time they’re 12 to 15 months old
• Don’t turn toward sounds or voices as they get older

Toddlers and older children may have hearing loss if they:

• Don’t respond when you talk to them or call their name
• Often ask people to repeat themselves or say “What?”
• Have trouble following directions or simple commands
• Turn up the volume on the TV, tablet or headphones
• Have trouble hearing when there’s background noise
• Have difficulty in school or often misunderstand their teacher
• Complain they can’t hear or that sounds seem muffled

What happens during pediatric hearing tests?

All babies born in the U.S. have newborn hearing screening tests to check if they can hear. Later, an audiologist may use different tests to check your child’s hearing.

Some tests simply measure how your child’s brain or the cochlear in their inner ear responds to sound. With these tests, an audiologist may place a soft earbud in your child’s ear. The earbud carries sound.

Other tests check how well your child can hear different sounds. The specific test depends on your child’s age and ability to respond to sound.

For example, an audiologist may use lights or toys to test hearing in babies and younger children. The lights or toys encourage children to respond to sounds.

Hearing tests for older children may involve playing sounds while your child wears headphones or earphones. When they hear a sound, children respond by pressing a button or playing a simple game.

Hearing test types

Some hearing tests screen for hearing loss. Other tests check for specific hearing issues.

Otoacoustic emissions test

An otoacoustic emissions (OAE) test checks how well the inner ear, especially the cochlea (hearing organ), responds to sound. The test is quick and painless. Children don’t need to respond to the sounds, so OAE is often used to check hearing in babies and young children.

Healthcare providers place a small, soft earbud (probe) in your child’s ear canal. The probe measures the sounds produced by the inner ear in response. A “pass” result usually means the inner ear is responding as expected, while a “refer” result may mean more testing is needed.

Auditory brainstem response

Your baby may also have this test as part of newborn hearing screening, but it’s also used to check hearing in older babies and toddlers. It checks the connection between your child’s inner ears and their brain. This connection enables us to hear.

As with an OAE, healthcare providers place soft earbuds in your child’s ears. Then, they put electrodes on their head. The electrodes connect to a computer. The earbuds deliver soft sounds to your child’s ears. Their brain reacts to the sounds. The electrodes record your child’s brainwave activity.

Your child may have other tests that check hearing based on their behavior, meaning what your child does or how they physically react to sounds. The test processes may seem complicated. You may worry that your young child may not understand the process or be intimidated by it. It may help to know that their audiologist will show you what goes into the tests. And they’ll explain ways your child can practice the test steps. That way, your child will be used to the test process and feel comfortable going through the steps.

Visual reinforcement audiometry

Visual reinforcement audiometry (VRA) is a “listen and look” game for infants ages 6 months to 3 years. With this test, when your child hears a sound, they look at or point to a visual target, like a toy or tablet. Looking or pointing when they hear a sound is an important part of VRA.

Your child has the test while sitting on your lap in the middle of a sound booth. Your audiologist will ask you to avoid giving hints or clues. Your child may wear headphones. Sometimes, the sounds come from a speaker.

Your child should react by turning their head toward the sound. They may also point at the sound’s direction.

There are ways to help your child get ready for a VRA test. First, help your child get used to wearing headphones so they’re comfortable with them during their VRA test.

You can play “listen and look” games with your child, such as:

1. Play a sound for your child. For example, set a timer on your phone.
2. When the timer sounds, coach your child to find the sound.
3. You may look where the sound comes from or point to it.
4. Praise your child for playing the game.
5. Keep on practicing listening and looking.

You can also help them get ready by pointing out sounds you hear at home, like a dog barking, birds chirping or a honking horn. Ask your child to find where the sound comes from.

Conditioned play audiometry

This test checks hearing in children aged 2 to 5 years old. In this test, your child sits at a table. They wear headphones so they can listen to the sounds their audiologist will play. Their audiologist may have buckets or boxes filled with small balls or blocks. They’ll tell your child to put a ball or block in the box or bucket when they hear a sound through the headphones.

During the test, your child’s audiologist plays sounds at different pitches and volumes. Like the AVR test, they’ll track the lowest volume your child can hear at different pitches.

You can prepare your child for a CPA test by practicing “listen and drop” games:

1. Have your child hold a toy or block by their ear.
2. Say “beep” or play a beeping sound on your phone.
3. When the sound plays, put your hand on your child’s hand to drop the toy or block into a bucket.
4. Practice this “hand-over-hand” task a few times. Then, let your child try on their own.
5. Make sure you encourage your child to wait for the sound before dropping the toy or block.

Your child will wear headphones for this test. Practice placing headphones on their head so they’re comfortable wearing them during the test.

Pure tone hearing test

This is the most common hearing test. It checks hearing in children aged 5 and up, as well as in adults. With this test, your child wears a headset or earbuds. A machine called an audiometer delivers sounds at different pitches and loudness. Your child raises their hand, presses a button or says “yes” whenever they hear a sound.

Their audiologist records your child’s response on an audiogram. Audiograms chart hearing loss patterns. The audiogram shows the degree of any hearing loss your child may have.

Tympanometry

This test checks for issues with your child’s eardrum and middle ear. It doesn’t measure how well your child hears. Instead, tympanometry shows how your child’s eardrum reacts to changes in air pressure and sound.

In this test, your child’s audiologist puts a small soft probe in your child’s ear. A small device attached to the probe pushes air into your child’s ear. The probe also plays a tone.

What do pediatric hearing test results look like?

For most hearing tests, your child’s results will be shown on a chart (audiogram) that shows how well they hear pitches and sounds at different volumes. Their audiologist will explain what’s going on with your child’s hearing and next steps. If your child has a tympanometry test, their results will show on a graph called a tympanogram.

When should I call my doctor?

Talk to your child’s pediatrician if you think your child has trouble hearing. Many things can cause hearing loss. Your child’s provider will check your child’s ears. They may recommend that your child see a pediatric audiologist.

How long does a pediatric hearing test take?

Test times range from 30 minutes to two hours, depending on the type of test. For example, an auditory brainstem test may take up to two hours. Behavioral tests like VRA and CPA may take 30 to 60 minutes. But check with your child’s audiologist for more specific information. They’ll be glad to answer any questions.

How else can I help my child prepare for a hearing test?

Hearing tests can be stressful for little ones. Here are some tips to help make the tests go as smoothly as possible:

• Ask the audiologist for calming techniques you can practice before the test to help your child stay relaxed.
• Explain that the audiologist will play hearing games with them.
• Make sure your child is well-rested and has something to eat before the test.
• Let them bring a favorite toy, but not one that makes noise.