Pediatric Audiology and Hearing Research - MedStar

The division of Pediatric Audiology and Hearing Research of MedStar Health is a division of the Department of Otolaryngology. We provide comprehensive pediatric diagnostic and rehabilitative services for both inpatient and outpatient care, all within a caring, patient-first environment.

Pediatric diagnostic services

Newborn hearing screening (AABR and OAE)

All newborn babies are screened for hearing loss prior to being discharged from the hospital. This program is provided by the Division of Audiology and is overseen by an audiologist.

Newborn hearing screening technicians are trained by audiologists to administer the test. Newborns who do not pass the test will be referred to someone who can provide information related to the testing, results, recommendations, or follow up.

Pediatric behavioral measurement of hearing sensitivity

Behavioral measurement is the gold standard for assessing hearing sensitivity. Regardless of the type of testing, you will be expected to participate in the process by holding your child on your lap. You will be instructed to not respond to anything that is happening in the room in order to not cue your child. You will sit in the center of a sound-treated room with your child on your lap.

Different sounds, from low pitch to high pitch, and speech will be used to assess your child's hearing sensitivity. These sounds will be played from a speaker in the room or from earphones, depending on the age of your child and what your child will tolerate. Our ultimate goal is for the child to wear earphones so that we may assess hearing in each individual ear (sounds from a speaker only enable us to assess the child's better hearing ear).

Your child's hearing sensitivity may be assessed in one of two ways:

Visual reinforcement audiometry (VRA)

To test hearing using VRA, your child will be conditioned to turn their head to look for the sound. In response to a correct head turn, a visual reinforcer, in the form of an animated toy, will be shown to your child. When sounds are not being presented, the child will play with a test assistant directly in front of you.

In order to participate in this type of testing, your child must be able to sit upright and turn their head (usually around age 1).

Conditioned play audiometry (CPA)

To test hearing using CPA, your child will be conditioned to throw a toy in a bucket every time they hear a sound. When sounds are not being played, your child will be asked to wait patiently for the next sound.

In order to participate in this testing, your child must have the impulse control to wait until they hear the sound to throw the block in the bucket (usually around age 2).

Older children

As your child gets older, we test hearing more like we would an adult. Once CPA becomes uninteresting for a child, as early as age 4, we ask them to raise their hand in response to the sound that they hear.

It is important to know that pediatric testing is very individualized. We will move at the pace that your child needs, and use fun, creative, and verified strategies to test your child's hearing. If your child is unable to be tested behaviorally, we have other methods to assess their hearing sensitivity.

ABR and ASSR testing (with and without sedation)

Electrophysiologic measurement of hearing sensitivity measures your child's hearing sensitivity directly from their hearing nerve. To measure, we use Auditory Brainstem Response (ABR) audiometry and Auditory Steady State Response (ASSR) Audiometry. These measures are impacted by body movement and brain activity, so it is important that your child sleeps during this test. ABR and ASSR testing can be performed if your child is unable to complete diagnostic behavioral testing.

For patients younger than four months, this testing may be completed under natural sleep. You will be asked to bring your baby into the clinic awake, hungry, and tired. We will clean your baby's skin and place small metal disks onto their forehead and earlobes using conductive paste and tape. You will then be asked to feed and/or soothe your child to encourage sleep.

Once your baby is asleep, small earphones will be placed in their ears and testing begins. Test time will depend on how long and how soundly your baby sleeps. Results may be given to you at the conclusion of the test, or may require analysis. If the test requires further analysis, your audiologist will contact you within a few days with test results.

For patients older than four months, sedation is required in order to ensure that your child sleeps throughout the test duration. In this case, an audiologist and the pediatric sedation team will work with you to schedule and prepare for this test.

Determination of middle ear function with acoustic immittance

Acoustic immittance measures include tympanometry and acoustic reflex testing and are used to assess middle ear function.

The anatomy of the ear is separated into three parts, the outer ear, the middle ear, and the inner ear. The middle ear begins at the tympanic membrane or eardrum. Behind the tympanic membrane is an air-filled cavity that is connected to the back of the throat via the Eustachian tube. At times, fluid abnormally fills this air-filled cavity and can cause temporary hearing loss or ear infections.

Using acoustic immittance, we can assess how well the tympanic membrane is moving and if there is an abnormal mass or fluid behind the tympanic membrane that may be affecting your child's ability to hear. If your child is found to have abnormal middle ear function, proper referrals will be made.

Pediatric treatment and rehabilitative services

Hearing aid evaluations

If your child has been diagnosed with a hearing loss that requires the use of hearing aids, you will be scheduled for a hearing aid evaluation. Together with your audiologist you will choose hearing aids that best meet your child's needs.

Your child will likely require the use of an ear mold to connect the hearing aid to their ear. Ear molds are custom made to fit your child's ear by filling your child's ear with a sticky pink substance. The substance dries in less than five minutes. Once removed, the impression will be sent to an ear mold lab. A custom ear mold will be made to precisely fit the size and shape of your child's ear.

Fitting and dispensing of digital hearing aids

A hearing aid fitting will occur approximately two to three weeks after your child's hearing aids have been ordered. A hearing aid is a device worn in or over the ear that amplifies sounds in the environment to make them audible.

Digital hearing aids are very sophisticated instruments. In order to fit your child's hearing aids, it must first be connected to the computer and programmed to your child's hearing loss. Some hearing aids need to be reprogrammed many times in order to meet your child's new listening needs.

Verification of programming using real ear measurements

Once your child's hearing aids are programmed for their hearing loss, it is important to verify that they are providing the correct amount of sound based off the size and shape of their ears. This verification is accomplished using Real Ear Measurements.

A small microphone is placed inside the child's ear canal, along with the hearing aid, to measure the output of the hearing aid in your child's ear. If the output of the hearing aid is found to be inappropriate, adjustments will be made to ensure your child is getting the sound they need.

Fitting of BAHA

The Division of Audiology is a licensed dispenser of BAHA.

Fitting and dispensing of FM systems

An FM system is a device used to reduce background noise and ensure audibility of a speech signal. Children commonly use an FM system so they may clearly hear a teacher in a classroom setting.

The FM system has two parts, a microphone and a receiver. The teacher wears the microphone and the receiver is connected to the child's hearing aid. The teacher's voice is transmitted from the microphone directly into the child's hearing aid. This reduces interference from noise sources in the classroom.

An FM system may be used by hearing-impaired children or children with normal hearing to help make speech more audible in a noisy situation.

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