Hearing tests Flashcards
What is the Otoacoustic emission test and when is it performed?
The Otoacoustic emission test is performed on newborns as part of the Newborn Hearing Screening Programme. It involves a computer-generated click played through a small earpiece, where a healthy cochlea emits a soft echo in response.
What is the Auditory Brainstem Response test and why might it be performed?
The Auditory Brainstem Response test may be performed on newborns and infants if the otoacoustic emission test is abnormal. It checks how the brain responds to sound.
What is the Distraction test and at what age is it performed?
The Distraction test is performed on children aged 6-9 months by a health visitor and requires two trained staff. It evaluates how well a child responds to sound distractions.
How is hearing tested in children aged 18 months to 2.5 years?
In children aged 18 months to 2.5 years, hearing is tested by asking them to recognize familiar objects such as a teddy or a cup and respond to simple questions.
Describe performance testing in children over 2.5 years.
Performance testing for children over 2.5 years involves assessing the child’s ability to follow instructions and respond to tasks in a testing environment.
What are speech discrimination tests and how are they performed in children over 2.5 years?
Speech discrimination tests for children over 2.5 years use objects with similar-sounding names to assess the child’s ability to discriminate between different sounds. Examples include the Kendall Toy test and McCormick Toy Test.
What is pure tone audiometry and at what age is it typically done?
Pure tone audiometry is a test done typically at school entry (around 3 years of age) in most areas of the UK. It measures a child’s ability to hear various pitches and volumes of sounds.
All newborn babies should have their hearing checked by the health visitor as part of the ‘Newborn Hearing Screening Programme’. If this is abnormal they go on to have which hearing test?
Otoacoustic emission test as a newborn/infant
Otoacoustic emission test at 6-9 months old
Auditory Brainstem Response test as a newborn/infant
Auditory Brainstem Response test at 6-9 months old
Pure tone audiometry as a newborn
Auditory Brainstem Response test as a newborn/infant
If a newborn baby has an abnormal hearing test at birth they are offered the auditory brainstem response test
All newborn babies should have an acoustic emission test, it is often done in the hospital prior to discharge home following birth. A soft earpiece is placed in the baby’s ear and quiet clicking sounds are played through it; the earpiece picks up the response from the inner ear and a computer analyses the results.
If this is abnormal an auditory brainstem response test is carried out as a newborn/infant. This involves three small sensors being placed on the baby’s head and neck, and soft headphones are used to play quiet clicking sounds; the sensors detect how your baby’s brain and hearing nerves respond to the sound and a computer analyses the results. Therefore, the correct answer is 3, if a newborn baby has an abnormal hearing test at birth they are offered the auditory brainstem response test as a newborn/infant.
A distraction test is carried out at 6-9 month of age.
Pure tone audiometry is done at school entry in most areas of the UK.
A paediatrician reviews a neonate with their mother on the ward round. The neonate is 19-hours-old and there are currently no concerns. Whilst on the ward round, the mother expresses concern with the child’s hearing, as her mother was deaf. She worries that her child will also have issues hearing.
What screening tool is most appropriate to consider for this patient?
6 month speech and language assessment
Impedance audiometry tests
Otoacoustic emission test
Pure tone audiometry
Weber’s and Rinnes
Otoacoustic emission test
Otoacoustic emission test is used to screen newborns for hearing problems
Important for meLess important
The otoacoustic emission test is one used is new-born screening. It is routine in the UK and if a newborn fails this test, they are then referred to have impedance audiometry testing. This is routine for all newborns.
A 6-month speech and language assessment does not exist. Babies are also unlikely to be talking by this stage.
Impedance audiometry testing is not routine and is only carried out if someone failed the otoacoustic emission test. As we do not know whether the patient failed her otoacoustic test, it would not be sensible to ask this before we determine if she had this test or not. The question also asks for routine tests.
Pure tone audiometry is only done when someone needs a hearing test. This is an adult hearing test and is not routinely performed.
Weber’s and Rinne’s are screening tools carried out by a clinician assessing for hearing loss - used for adults. The child is unlikely to comply with the test making it difficult to assess hearing using these methods.
summarise
A newborn baby is undergoing the routine newborn and infant physical examination before hospital discharge. The pregnancy was uneventful, and delivery occurred without complications at 39 weeks gestation. Both the mother and newborn are considered well enough for discharge. However, during the examination, the midwife observed that the automated otoacoustic emission test failed to produce an audible response, with repeat testing yielding similar results.
What is the next management step?
Auditory brainstem response test
Distraction test
Performance testing
Pure tone audiometry
Speech discrimination test
Auditory brainstem response test
If a newborn baby has an abnormal hearing test at birth they are offered the auditory brainstem response test
The correct answer is auditory brainstem response test. This infant is undergoing an otoacoustic emission test as part of the routine newborn and infant physical examination before hospital discharge. The procedure entails placing a small, soft-tipped earpiece in the baby’s ear to emit gentle clicking sounds. An audible soft echo suggests a functioning cochlea. However, in this instance, the absence of an echo on two occasions raises concerns about potential hearing impairment.
As a result, the infant should be referred for an auditory brainstem response test. This diagnostic assessment involves affixing three small sensors to the baby’s head and neck and fitting soft headphones over their ears to play clicking sounds. The test measures the auditory nerve and brainstem’s responses to these sounds. It is crucial to note that not all infants who need further evaluation have hearing problems; sometimes, fluid in the middle ear at birth or ambient noise may interfere with testing accuracy.
A distraction test is appropriate for children aged six to eight months developmentally and evaluates whether an infant can hear a sound and then turn towards its source. Sounds are generated from behind the child on either side, outside their visual field, using various stimuli such as rattles, human voices, drums, and warble tones. The intensity of these sounds is adjusted to determine the quietest level detectable by the infant. As newborns lack sound localisation capabilities, this method is unsuitable for them.
Performance testing requires teaching children to listen for a sound and respond when they hear it through play-based activities—such as placing a ring on a peg upon hearing a specific sound—which necessitates certain developmental skills absent in newborns.
Pure tone audiometry is commonly conducted when children start school across the UK. During this test, sounds of varying volumes and frequencies are produced by a machine and transmitted through headphones; children indicate their perception of these sounds by pressing a button. Newborns cannot participate due to their stage of development.
Lastly, speech discrimination tests assess a child’s ability to discern words at different listening levels by having them identify toys or pictures or repeat words spoken directly or played back from recordings. These tests also evaluate lip-reading and signing abilities but require advanced skills beyond those of newborns.
A 29-year-old woman who is 38 weeks pregnant contacts you to ask for information about the newborn hearing screening programme. She is worried about damage to her baby’s ears and is unsure if she wants to consent to this screening.
What test is offered to all newborn babies as part of this screening programme?
Auditory brainstem response test
Automated otoacoustic emission test
Play audiometry
Pure tone audiometry
Visual reinforcement audiometry
Automated otoacoustic emission test
Otoacoustic emission test is used to screen newborns for hearing problems
The correct answer is automated otoacoustic emission test. This is the test used in newborn hearing screening and involves putting a small soft-tipped earpiece in the outer part of a baby’s ear which sends clicking sounds down the ear. The presence of a soft echo indicates a healthy cochlea.
Auditory brainstem response test is incorrect. This may be done by an audiologist if a baby is not found to have satisfactory hearing during newborn screening with the automated otoacoustic emission test. It involves placing small sensors on the baby, sounds of different frequencies are played into their ears and a computer records the response.
Play audiometry is incorrect. Children between two and five years old may have a play audiometry test. It is not suitable for newborns as the child is required to perform a simple task when they hear a sound.
Pure tone audiometry incorrect. It is used in older children (school age) and adults and is not suitable for use in newborns as the patient must respond when they hear a noise by pressing a button.
Visual reinforcement audiometry is incorrect. This is usually used to test hearing in children from approximately seven months of age up to two-and-a-half years old. It is not suitable for newborns as a child is required to link sounds to a visual reward such as a toy.
