Evaluation of Children 6 Months to 3 Years
Audiological Diagnostic Assessment Protocol
1. Detailed history should include but is not limited to:
- Parental report of auditory and visual behaviors
- Motor development
- Family history of hearing loss
- History of middle ear pathologies
- Parental concerns
- Prenatal, birth, and neonatal history
- Medical history including: Syndromes or other inheritable conditions, craniofacial abnormalities, kidney issues, conditions of limbs/digits, pigmentation issues, exposure to ototoxic medications
2. Otoscopy:
Visual inspection for obvious structural abnormalities of the pinna and ear canal
3. Evoked Otoacoustic Emissions:
- Transients or Distortion Products
- TEOAE click stimuli: One level (e.g., 80-85 dB pSPL) should be completed.
- DPOAE stimuli: Use L1/L2 of 65/55 dB SPL
- Pass criterion: Emission of 6 dB signal to noise ratio for at least three frequencies in each ear. At least one frequency should be located between 2000 and 3000 Hz A second frequency should be located between 3000 and 4000 Hz
- The third point could be at any other frequency between 1000 Hz and 6000 Hz
4. Acoustic Immitance Testing:
- Tympanometry - 660 Hz or higher probe tone in children under 6-18 months
- 220Hz is acceptable in children 18-36 months
5. Acoustic Reflex
- Ipsilateral middle ear muscle reflex thresholds for 500, 1000, 2000, and 4000
- Pass Criterion: Type A tympanogram and present acoustic reflexes
6. Behavioral Observation Audiometry (BOA)
- In soundfield or with earphones using calibrated stimuli. Insert earphones are recommended if possible.
- Pass criterion: minimal and/or startle response at 65 dB.
7. Visual Reinforcement Audiometry (VRA): (if appropriate due to child's developmental level)
- Stimuli should be speech and also frequency specific tones between 250- 6000 Hz.
- Insert earphones are preferable; sound field may be necessary with some children who will not tolerate earphones.
- Pass Criterion: 20 dB to speech and threshold responses at 500, 1000, 2000, and 4000 Hz tones.
8. At least one ABR is recommended as part of a complete audiology diagnostic evaluation for children younger than 3 years old for confirmation of permanent hearing loss. (The same procedures as outlined in newborn-6 months for recommended ABR procedures apply.)
