Hearing Tests

Kids who have hearing loss have trouble hearing or understanding some or all sounds. This can happen when there is a problem with:

• one or more parts of the ears
• the nerves that send sound signals from the ears to the brain
• the part of the brain that makes sense of these signals

Even mild hearing loss in children can cause problems with speech, language, learning, and social skills. That’s why it's important to get your child's hearing screened at birth and checked regularly.

When Should Hearing Be Checked?

It’s best to catch hearing problems early, because treatment is more successful if it starts before a child is 6 months old. That’s why every newborn has a hearing screening test before leaving the hospital. 

If your baby doesn't have a screening before going home, or was born at home or a birthing center, get their hearing checked within the first 3 weeks of life. Not passing a hearing screening doesn’t mean a baby has hearing loss, but it does mean that the baby should have a full hearing evaluation within 3 months. If hearing loss is found then, treatment should begin right away.

Kids should continue to have their hearing checked at their regular checkups. Hearing screening tests usually are done at:

• ages 4, 5, 6, 8, and 10 years
• the preteen years
• the teen years

The doctor will also check hearing any other time there's a concern. Tell your child’s doctor if you are concerned about a hearing problem.

How Is Hearing Tested?

Hearing is checked by a hearing specialist called an audiologist. The type of test they do depends on a child's age, development, and health.

Many kids get behavioral hearing tests. These tests check to see a child’s response to sounds like calibrated speech (speech that is played with a particular volume) and pure tones. A pure tone is a sound with a specific pitch (frequency), like a note on a keyboard.

During a test, audiologists watch for a behavioral response after a child hears a sound. Babies or toddlers may make eye movements or turn their head. Older kids may move a game piece in response to a sound, and a grade-schooler may raise their hand. Children also can respond to speech with activities like pointing to a picture or toy, or repeating words softly.

Other tests can be done to check hearing if a child is too young or not able to cooperate with behavioral testing. These tests look at how well the ear, nerves, and brain are working.

Other Tests to Check Ears and Hearing

Tympanometry

Tympanometry (tim-peh-NOM-eh-tree) shows how well the eardrum moves and can help find middle ear problems, such as fluid behind the eardrum or a perforated eardrum (a hole in the eardrum). 

During this test, the audiologist puts a tympanometer (tim-peh-NOM-eh-tur) probe with a small, rubber tip in the child’s ear. It sends a soft sound and a puff of air into the ear canal. Test results appear on a graph called a tympanogram (tim-PAN-oh-gram). The shape of the graph tells how the eardrum is moving.

Middle Ear Muscle Reflex (MEMR) Test

A tiny muscle inside the ear tightens when we hear a loud noise. This is called the middle ear muscle reflex (MEMR). This reflex helps protect the ear against loud sounds, which can harm hearing. Doctors can tell a lot about a child’s hearing based on how well this reflex works.

For the MEMR test, the audiologist puts the soft rubber tip of the tympanometer into the child’s ear canal. The probe makes a series of loud sounds. A machine records how well the middle ear muscle reflex responds to the sounds.

Otoacoustic Emissions (OAE) Test

The ear gathers sound from the environment and turns them into messages the brain can understand. But sometimes these messages won’t go through or are jumbled. When this happens, doctors check to see if the cochlea (the organ of hearing, which creates the messages) is working properly. They use an OAE test.

During the test, the audiologist puts soft earphones gently into each ear canal. They have small, flexible foam tips. The earphones make high and low pitch sounds. Then, the machine records the response made by the cochlea’s outer hair cells.

Hospitals use OAE for newborn hearing screening. A baby that fails this screening will need a full hearing evaluation.

Auditory Brainstem Response (ABR) Test

An auditory brainstem response (or ABR) test can tell how well the auditory nerve works. This is the hearing nerve that leads from the ear to the brain.

During the test, the audiologist places tiny earphones in the child’s ear canals and soft electrodes (small sensor stickers) behind the ears and on the forehead. Clicking sounds and tones (pitches) are sent through the earphones. The electrodes measure the hearing nerve and brain's response to these sounds.

Hospitals use a screening ABR for newborn hearing screening. A baby that fails this screening will need a full ABR or hearing evaluation, depending on their age.

Auditory Steady State Response (ASSR) Test

Audiologists sometimes do the ASSR test with (not instead of) ABR to better understand the level of hearing loss. An infant usually is sleeping or gets medicine to help them sleep for this test.

During the test, sound passes into the ear canals, and a computer picks up the brain's response to the sound.

Central Auditory Evoked Potential (CAEP) Test

The CAEP test lets the audiologist see if the hearing pathways from the lowest part of the (the brainstem) to the hearing part of the brain (auditory cortex) are working as they should. 

This test also uses tiny earphones and small electrodes (sensor stickers) put behind the ears and on the forehead. The earphones make clicking sounds and beeps in different tones. The electrodes measure the hearing nerve and brain's response to the sounds.

What Else Should I Know?

If your child is diagnosed with a hearing problem, the audiologist will work closely with doctors, speech-language therapists, and education specialists to create a treatment plan for your child.

It also can help to meet other families of kids with hearing loss. Reach out to a local support group or ask a member of your care team about local programs where you can connect.

You also can find more information and support online at:

• Hearing Loss Association of America
• Supporting Success for Children with Hearing Loss
• Alexander Graham Bell Association
• Hearing First